心脏瓣膜手术术前贫血纠正方式及程度与预后的研究*

doi:10.3969/j.issn.1671-2587.2026.03.008

临床输血与检验 ›› 2026, Vol. 28 ›› Issue (3): 345-354.DOI: 10.3969/j.issn.1671-2587.2026.03.008

心脏瓣膜手术术前贫血纠正方式及程度与预后的研究^*

陈羽佳¹, 姜艺², 沈星¹, 郁金凤¹, 范阜东², 陈青¹

¹南京大学医学院附属鼓楼医院输血医学科,江苏南京 210008;
²南京大学医学院附属鼓楼医院心脏外科,江苏南京 210008

收稿日期:2026-03-09 出版日期:2026-06-20 发布日期:2026-07-07
通讯作者: 陈青,主要从事输血医学研究,（E-mail）qchen@njglyy.com。
作者简介:陈羽佳,主要从事临床输血研究,（E-mail）449292572@qq.com。
基金资助:
^*本课题受南京市卫生科技发展专项资金医学重点科技发展项目（No.ZKX24022）、南京鼓楼医院引进人才科研启动项目（No.RC2022-028）资助

Study on Preoperative Anemia Correction Strategy and Correction Magnitude in Patients Undergoing Cardiac Valve Surgery and Their Association with Prognosis

CHEN Yujia¹, JIANG Yi², SHEN Xing¹, YU Jinfeng¹, FAN Fudong², CHEN Qing¹

¹Department of Transfusion Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008;
²Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008

Received:2026-03-09 Online:2026-06-20 Published:2026-07-07

摘要/Abstract

摘要： 目的探讨心脏瓣膜手术合并贫血患者术前贫血纠正方式及血红蛋白纠正幅度与出院后30天内全因死亡风险的关系。方法回顾性分析2020年1月—2022年12月于南京大学医学院附属鼓楼医院首次接受体外循环下心脏瓣膜手术且符合世界卫生组织贫血标准的369例成年患者临床资料。根据术前贫血纠正方式和纠正幅度分组,采用倾向评分匹配（propensity score matching, PSM）均衡基线特征。应用单因素及多因素Logistic回归分析出院后30天内全因死亡危险因素;根据血红蛋白纠正值将患者分为<-10、-10~<0、0~<15及≥15 g/L四组,比较不同纠正幅度与死亡率关联。结果经PSM后,输血纠正组较药物纠正组出院后30天内全因死亡风险呈升高趋势,该差异虽具有临床警示意义,但未达到统计学显著（aOR=3.038,95%CI 0.909~10.152,P=0.071）。按血红蛋白纠正值分层后,四组患者30天内全因死亡率分别为21.7%、4.5%、11.7%和33.3%,差异具有统计学意义（P=0.04）,死亡风险随纠正幅度变化呈“U型”分布趋势。此外,年龄为30天内全因死亡独立危险因素（aOR=1.097,95%CI 1.042~1.155,P<0.001）。结论术前贫血纠正方式及纠正幅度可能影响心脏瓣膜手术患者短期预后。围术期患者血液管理可优先考虑病因导向的药物纠正策略,并关注血红蛋白变化幅度,避免纠正不足或过度纠正带来潜在不良预后。

关键词: 心脏瓣膜手术, 术前贫血, 贫血纠正方式, 血红蛋白纠正值, 倾向评分匹配, 患者血液管理

Abstract: Objective To investigate the associations of preoperative anemia correction strategy and hemoglobin (Hb) correction magnitude with the risk of all-cause mortality within 30 days following discharge in anemic patients undergoing cardiac valve surgery. Methods We retrospectively analyzed the clinical data of 369 adult patients with anemia defined according to the World Health Organization criteria who underwent primary cardiac valve surgery under cardiopulmonary bypass at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University between January 2020 and December 2022. Patients were categorized according to preoperative anemia correction strategy and Hb correction magnitude. Propensity score matching (PSM) was used to balance baseline characteristics. Univariate and multivariate Logistic regression analyses were performed to evaluate risk factors for 30-day all-cause mortality after discharge. According to the Hb correction value, patients were classified into four groups:<-10, -10 to <0, 0 to <15, and≥15 g/L, and the association between different correction magnitudes and mortality was assessed. Results After PSM, the transfusion correction group showed a trend toward a higher risk of 30-day all-cause mortality than the pharmacological correction group. The difference was not statistically significant, although a potential clinically relevant trend was observed (aOR=3.038, 95%CI 0.909~10.152, P=0.071). After stratification by Hb correction value, the 30-day all-cause mortality rates in the four groups were 21.7%, 4.5%, 11.7%, and 33.3%, respectively; and the difference was statistically significant (P=0.04). The mortality risk tended to show a U-shaped distribution with the change in correction amplitude. In addition, age was an independent risk factor for 30-day all-cause mortality after discharge (aOR=1.097, 95%CI: 1.042~1.155, P<0.001). Conclusion The correction strategy and correction amplitude of preoperative anemia may be associated with short-term prognosis in patients undergoing heart valve surgery. In perioperative patient blood management, pharmacological correction based on etiology may be a preferable option, and close attention should be paid to the magnitude of Hb change to avoid the potential adverse prognosis associated with under-correction or over-correction.

Key words: Cardiac valve surgery, Preoperative anemia, Anemia correction strategy, Hemoglobin correction value, Propensity score matching, Patient blood management

中图分类号:

R654.2R556

陈羽佳, 姜艺, 沈星, 郁金凤, 范阜东, 陈青. 心脏瓣膜手术术前贫血纠正方式及程度与预后的研究^*[J]. 临床输血与检验, 2026, 28(3): 345-354.

CHEN Yujia, JIANG Yi, SHEN Xing, YU Jinfeng, FAN Fudong, CHEN Qing. Study on Preoperative Anemia Correction Strategy and Correction Magnitude in Patients Undergoing Cardiac Valve Surgery and Their Association with Prognosis[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2026, 28(3): 345-354.

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心脏瓣膜手术术前贫血纠正方式及程度与预后的研究^*

Study on Preoperative Anemia Correction Strategy and Correction Magnitude in Patients Undergoing Cardiac Valve Surgery and Their Association with Prognosis

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