Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

doi:10.12114/j.issn.1007-9572.2022.0333

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (33): 4185-4190.DOI: 10.12114/j.issn.1007-9572.2022.0333

Special Issue: 睡眠问题专题研究

• Article • Previous Articles Next Articles

Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

1.The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
2.Xinyi Hospital of Traditional Chinese Medicine, Xinyi 221499, China

Received:2022-07-11 Revised:2022-07-21 Published:2022-11-20 Online:2022-09-08
Contact: DING Ning
About author:
LI Y, WANG Y, CHEN X, et al. Relationship between pulse oxygen desaturation rate and heart rate fluctuation rate and arrhythmias in patients with obstructive sleep apnea hypopnea syndrome[J]. Chinese General Practice, 2022, 25 (33) : 4185-4190, 4195.

脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究

1.210029　江苏省南京市，南京医科大学第一附属医院
2.221499　江苏省新沂市中医医院

通讯作者: 丁宁
作者简介:
李勇，王颖，陈勋，等.脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究[J].中国全科医学，2022，25（33）：4185-4190，4195. [www.chinagp.net] 作者贡献：李勇、王颖、陈勋、林蔚负责研究过程的实施，包括病例基本信息的采集、各项临床指标的收集；张凯、丁宁负责统计学分析；李勇、王颖、陈勋、林蔚、张凯、丁宁负责论文起草、修改和最终版本修订；丁宁提出研究思路，设计研究方案，对论文负责。
基金资助:
国家自然科学基金面上项目(82070093); "511腾飞工程"青年医师项目(JSPH-511C-2018-10)

Abstract

Abstract:

Background

Arrhythmias are common complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) , however their occurrence and severity are not completely consistent with the severity of their disease per se. Our previous study found that pulse oxygen desaturation rate (ODR) was an independent predictor of the development of hypertension in OSAHS patients. We hypothesized that sleep apnea related ODR and heart rate fluctuation rate (HRFR) may predict the occurrence of arrhythmias in OSAHS patients.

Objective

To observe the correlation between ODR, HRFR and the occurrence of arrhythmias, and to explore the predictive value of ORD and HRFR on the occurrence of arrhythmias.

Methods

Polysomnography and Holter monitoring were performed on 36 patients who visited the sleep disordered breathing specialized outpatient clinic of the First Affiliated Hospital of Nanjing Medical University between January and June 2021, while basic clinical information of the patients was collected. Taking the median number of arrhythmic events as the cutoff value, the patients were divided into two groups: the patients with low incidence of arrhythmia group (<105 events) and with high incidence of arrhythmias group (≥105 events) . ODR and HRFR were analyzed for correlation with arrhythmias and Logistic regression was performed for analysing the predictors of arrhythmia.

Results

Compared with low incidence of arrhythmia group, the patients with high incidence of arrhythmias had higher ODR and HRFR (P<0.05) . Correlation analysis showed that the number of total arrhythmic events was positively correlated with ODR, mean heart rate fluctuation value, and HRFR (r_s=0.472, 0.719, 0.360, and 0.393, respectively, P<0.05) . Multivariate Logistic regression analysis showed that ODR〔OR=77.849, 95%CI (5.250, 1 154.301) , P<0.05〕and HRFR 〔OR=9.981, 95%CI (1.000, 105.600) , P=0.05〕were independent risk factors for arrhythmic events. The area under the receiver operator characteristic (AUC) of ODR and HRFR for predicting multiple arrhythmias were 0.932 〔95%CI (0.830, 0.941) 〕 and 0.753 〔95%CI (0.590, 0.916) , respectively.

Conclusion

ODR and HRFR are associated with the occurrence of arrhythmias and can be used for predicting the occurrence of arrhythmic events in patients with OSAHS.

Key words: Sleep apnea, obstructive, Cardiac dysrhythmia, Oxygen desaturation rate, Heart rate fluctuation rate, Root cause analysis, Forecasting

摘要：

背景

心律失常是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的常见并发症，然而OSAHS患者心律失常的发生及严重程度与其疾病本身严重程度并不完全一致。本研究团队前期研究发现脉氧下降率（ODR）是OSAHS患者发生高血压的独立预测因素，推测呼吸暂停事件相关的ODR和心率波动率（HRFR）可能预测OSAHS患者心律失常的发生。

目的

探讨ODR及HRFR与OSAHS患者发生心律失常的相关性，ODR及HRFR对心律失常发生的预测价值。

方法

2021年1—6月对在南京医科大学第一附属医院睡眠呼吸障碍专病门诊就诊的36例患者行多导睡眠监测和动态心电图监测，同时收集患者基本临床资料信息。以心律失常事件数的中位数为截断值，把患者分为少发心律失常组（心律失常事件数<105次）和多发心律失常组（心律失常事件数≥105次）各18例。采用Spearman秩相关分析探究ODR、HRFR与心律失常发生的相关性，采用多因素Logistic回归分析探讨OSAHS患者发生心律失常的影响因素。

结果

多发心律失常组患者ODR和HRFR高于少发心律失常组（P<0.05）。相关性分析显示，总心律失常事件数与年龄、ODR、单位时间心率变化幅度（?HR）、HRFR呈正相关（r_s=0.472、0.719、0.360、0.393，P<0.05）；多因素Logistic回归分析显示ODR〔OR=77.849，95%CI（5.250，1 154.301），P<0.05〕和HRFR〔OR=9.981，95%CI（1.000，105. 600），P=0.05〕是OSAHS患者心律失常发生的影响因素。ODR和HRFR预测多发心律失常的受试者工作特征曲线下面积（AUC）分别为0.932〔95%CI（0.830，0.941）〕和0.753〔95%CI（0.590，0.916）〕。

结论

ODR和HRFR与OSAHS患者心律失常的发生具有相关性，能够预测OSAHS患者心律失常的发生。

关键词: 睡眠呼吸暂停, 阻塞性, 心律失常, 脉氧下降率, 心率波动率, 影响因素分析, 预测

LI Yong,WANG Ying,CHEN Xun, et al. Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome[J]. Chinese General Practice, 2022, 25(33): 4185-4190. DOI: 10.12114/j.issn.1007-9572.2022.0333.
李勇,王颖,陈勋等. 脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究[J]. 中国全科医学, 2022, 25(33): 4185-4190. DOI: 10.12114/j.issn.1007-9572.2022.0333.

Figures/Tables 6

References 25

[1]	张建琴.南方医院睡眠中心及心内科住院病人阻塞性睡眠呼吸暂停低通气综合征流行病学调查及其与心血管病关系研究[D]. 广州：南方医科大学，2017.
[2]	ARIAS M A, SÁNCHEZ A M. Obstructive sleep apnea and its relationship to cardiac arrhythmias[J]. J Cardiovasc Electrophysiol，2007，18(9):1006-1014. DOI：10.1111/j.1540-8167.2007.00891.x.
[3]	PARISH J M, SOMERS V K. Obstructive sleep apnea and cardiovascular disease[J]. Mayo Clin Proc，2004，79(8):1036-1046. DOI：10.4065/79.8.1036.
[4]	MEHRA R, BENJAMIN E J, SHAHAR E，et al. Association of nocturnal arrhythmias with sleep-disordered breathing：the sleep heart health study[J]. Am J Respir Crit Care Med，2006，173(8):910-916. DOI：10.1164/rccm.200509-1442OC.
[5]	DI FUSCO S A, PIGNALBERI C, SANTINI L，et al. Arrhythmias and sleep apnea：physiopathologic link and clinical implications[J]. J Interv Card Electrophysiol，2020，57(3):387-397. DOI：10.1007/s10840-020-00707-z.
[6]	SHEPARD J W J, GARRISON M W, GRITHER D A，et al. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea[J]. Chest，1985，88(3):335-340. DOI：10.1378/chest.88.3.335.
[7]	WANG N N, MENG Z L, DING N，et al. Oxygen desaturation rate as a novel intermittent hypoxemia parameter in severe obstructive sleep apnea is strongly associated with hypertension[J]. J Clin Sleep Med，2020，16(7):1055-1062. DOI：10.5664/jcsm.8396.
[8]	中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南（2011年修订版）[J]. 中华结核和呼吸杂志，2012，1:9-12. DOI：10.3760/cma.j.issn.1001-0939.2012.01.007.
[9]	YEGHIAZARIANS Y, JNEID H, TIETJENS J R，et al. Obstructive sleep apnea and cardiovascular disease：a scientific statement from the American heart association[J]. Circulation，2021，144(3):e56-67. DOI：10.1161/CIR.0000000000000988.
[10]	ALMENEESSIER A S, ALASOUSI N, SHARIF M M，et al. Prevalence and predictors of arrhythmia in patients with obstructive sleep apnea[J]. Sleep Sci，2017，10(4):142-146. DOI：10.5935/1984-0063.20170025.
[11]	王君，郑小兵，张希龙，等. 心血管病患者中阻塞性睡眠呼吸暂停的临床特征及危险因素分析[J]. 临床肺科杂志，2022，27(6):817-821.
[12]	王晓舟，殷西亮，王晓娟，等. 睡眠呼吸暂停综合征对冠心病患者心律失常发生的影响[J]. 数理医药学杂志，2011，24(6):682-684. DOI：10.3969/j.issn.1004-4337.2011.06.017.
[13]	黄芃菲，叶岚. 阻塞性睡眠呼吸暂停低通气综合征与心律失常的相关性[J]. 心血管病学进展，2018，39(6):923-926. DOI：10.16806/j.cnki.issn.1004-3934.2018.06.014.
[14]	刘新兵，周明成，李毅刚. 阻塞性睡眠呼吸暂停综合征和心血管事件相关性及其机制探讨[J]. 心血管康复医学杂志，2012，21(3):335-337. DOI：10.3969/j.issn.1008-0074.2012.03.38.
[15]	RIAZ S, BHATTI H, SAMPAT P J，et al. The converging pathologies of obstructive sleep apnea and atrial arrhythmias[J]. Cureus，2020，12(7):e9388. DOI：10.7759/cureus.9388.
[16]	朱凌霞，佟光明，尤涛，等. 睡眠呼吸暂停低通气综合征患者QT离散度及心律失常临床研究[J]. 中国全科医学，2013，16(30):3551-3553. DOI：10.3969/j.issn.1007-9572.2013.28.082.
[17]	郭辉，李学文. 阻塞性睡眠呼吸暂停低通气综合征患者心律失常的发生及相关因素的研究[J]. 中国心脏起搏与心电生理杂志，2015，29(5):462-465. DOI：10.13333/j.cnki.cjcpe.2015.05.008.
[18]	OLMETTI F, LA ROVERE M T, ROBBI E，et al. Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea[J]. Sleep Med，2008，9(5):475-480. DOI：10.1016/j.sleep.2007.08.015.
[19]	MONAHAN K, STORFER-ISSER A, MEHRA R，et al. Triggering of nocturnal arrhythmias by sleep-disordered breathing events[J]. J Am Coll Cardiol，2009，54(19):1797-1804. DOI：10.1016/j.jacc.2009.06.038.
[20]	VIZZARDI E, SCIATTI E, BONADEI I，et al. Obstructive sleep apnoea-hypopnoea and arrhythmias：new updates[J]. J Cardiovasc Med（Hagerstown），2017，18(7):490-500. DOI：10.2459/JCM.0000000000000043.
[21]	STROHL K P, ALTOSE M D. Oxygen saturation during breath-holding and during apneas in sleep[J]. Chest，1984，85(2):181-186. DOI：10.1378/chest.85.2.181.
[22]	LOMBARDI C, FAINI A, MARIANI D，et al. Nocturnal arrhythmias and heart-rate swings in patients with obstructive sleep apnea syndrome treated with beta blockers[J]. J Am Heart Assoc，2020，9(21):e015926. DOI：10.1161/JAHA.120.015926.
[23]	WANG X T, ZHAO G, TU L，et al. Continuous positive airway pressure effectively alleviates arrhythmias in patients with obstructive sleep apnea：possible relationship with counteracting oxidative stress[J]. Curr Med Sci，2019，39(1):52-58. DOI：10.1007/s11596-019-1999-1.
[24]	ABUMUAMAR A M, NEWMAN D, DORIAN P，et al. Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation[J]. J Interv Card Electrophysiol，2019，54(3):289-297. DOI：10.1007/s10840-018-0482-4.
[25]	WANG X T, YUE Z Y, LIU Z H，et al. Continuous positive airway pressure effectively ameliorates arrhythmias in patients with obstructive sleep apnea-hypopnea via counteracting the inflammation[J]. Am J Otolaryngol，2020，41(6):102655. DOI：10.1016/j.amjoto.2020.102655.

组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	男性〔n（%）〕	BMI 〔M（P₂₅，P₇₅），kg/m²〕	ESS评分〔M（P₂₅，P₇₅），分〕
少发心律失常组	18	49（36，59）	14（77.8）	28.0（26.4，32.6）	13.0（7.0，16.0）
多发心律失常组	18	60（44，73）	18（100.0）	26.3（23.5，27.9）	14.0（6.0，18.0）
Z值		-1.615	—	-2.199	-0.444
P值		0.106	0.104	0.028	0.657
组别	AHI 〔M（P₂₅，P₇₅），次/h〕	平均SpO₂ 〔M（P₂₅，P₇₅），%〕	最低SpO₂ 〔M（P₂₅，P₇₅），%〕	T90% 〔M（P₂₅，P₇₅），%〕
少发心律失常组	15.8（9.6，37.1）	93.0（92.0，95.0）	80.0（69.0，84.0）	4.5（1.0，17.5）
多发心律失常组	20.1（9.4，46.3）	93.0（91.0，95.0）	78.0（68.0，86.0）	11.0（2.0，33.0）
Z值	-0.506	-0.830	-0.269	-0.888
P值	0.613	0.424	0.788	0.375
组别	∆S 〔M（P₂₅，P₇₅）〕	ODR 〔M（P₂₅，P₇₅）〕	∆HR 〔M（P₂₅，P₇₅）〕	HRFR 〔M（P₂₅，P₇₅）〕
少发心律失常组	15.0（10.0，20.0）	0.5（0.3，0.7）	9.0（5.0，15.0）	0.6（0.5，1.1）
多发心律失常组	14.0（9.0，21.0）	1.0（0.8，1.2）	14.0（12.0，18.0）	1.3（0.9，1.7）
Z值	-0.237	-4.430	-1.915	-2.595
P值	0.812	<0.001	0.055	0.009

组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	男性〔n（%）〕	BMI 〔M（P₂₅，P₇₅），kg/m²〕	ESS评分〔M（P₂₅，P₇₅），分〕
少发心律失常组	18	49（36，59）	14（77.8）	28.0（26.4，32.6）	13.0（7.0，16.0）
多发心律失常组	18	60（44，73）	18（100.0）	26.3（23.5，27.9）	14.0（6.0，18.0）
Z值		-1.615	—	-2.199	-0.444
P值		0.106	0.104	0.028	0.657
组别	AHI 〔M（P₂₅，P₇₅），次/h〕	平均SpO₂ 〔M（P₂₅，P₇₅），%〕	最低SpO₂ 〔M（P₂₅，P₇₅），%〕	T90% 〔M（P₂₅，P₇₅），%〕
少发心律失常组	15.8（9.6，37.1）	93.0（92.0，95.0）	80.0（69.0，84.0）	4.5（1.0，17.5）
多发心律失常组	20.1（9.4，46.3）	93.0（91.0，95.0）	78.0（68.0，86.0）	11.0（2.0，33.0）
Z值	-0.506	-0.830	-0.269	-0.888
P值	0.613	0.424	0.788	0.375
组别	∆S 〔M（P₂₅，P₇₅）〕	ODR 〔M（P₂₅，P₇₅）〕	∆HR 〔M（P₂₅，P₇₅）〕	HRFR 〔M（P₂₅，P₇₅）〕
少发心律失常组	15.0（10.0，20.0）	0.5（0.3，0.7）	9.0（5.0，15.0）	0.6（0.5，1.1）
多发心律失常组	14.0（9.0，21.0）	1.0（0.8，1.2）	14.0（12.0，18.0）	1.3（0.9，1.7）
Z值	-0.237	-4.430	-1.915	-2.595
P值	0.812	<0.001	0.055	0.009

项目	年龄	BMI	高血压	ESS	AHI	平均SpO₂	最低SpO₂	T90%	∆S	ODR	∆HR	HRFR
r_s值	0.472	-0.390	-0.005	-0.044	0.025	-0.043	0.046	0.105	-0.050	0.719	0.360	0.393
P值	0.004	0.019	0.975	0.799	0.887	0.801	0.789	0.540	0.771	<0.001	0.031	0.018

项目	年龄	BMI	高血压	ESS	AHI	平均SpO₂	最低SpO₂	T90%	∆S	ODR	∆HR	HRFR
r_s值	0.472	-0.390	-0.005	-0.044	0.025	-0.043	0.046	0.105	-0.050	0.719	0.360	0.393
P值	0.004	0.019	0.975	0.799	0.887	0.801	0.789	0.540	0.771	<0.001	0.031	0.018

项目	赋值
性别	女=1，男=2
年龄	年龄<55岁=1，年龄≥55岁=2
BMI	BMI<27 kg/m²=1，BMI≥27 kg/m²=2
高血压	无=1，有=2
AHI	AHI<15次/h=1，AHI≥15次/h=2
平均SpO₂	平均SpO₂>90%=1，平均SpO₂≤90%=2
最低SpO₂	最低SpO₂>80%=1，最低SpO₂≤80%=2
T90%	T90%<10%=1，T90%≥10%=2
∆S	∆S<15=1，∆S≥15=2
ODR	ODR<0.8%=1，ODR≥0.8%=2
∆HR	∆HR<13=1，∆HR≥13=2
HRFR	HRFR<0.9%=1，HRFR≥0.9%=2

Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 25

Related Articles 15

Recommended Articles

Metrics

Comments

变量	SE	β	P值	OR值	95%CI
ODR（以<0. 8为参考）	1. 376	4. 355	0. 002	77. 849	（5. 250，1 154. 301）
HRFR（以<0. 9为参考）	1. 204	2. 301	0. 050	9. 981	（1.000，105. 600）
常量	3. 126	-9. 367	0. 003	0	—

[1]	CHU Xiaojing, LI Jun, FU Yanqin, LIU Danqing, LIU Aiping, ZHANG Yuanyuan. Effect of Human Body Composition and Serum Biochemical Indicators on the Accuracy of Flash Glucose Monitoring System [J]. Chinese General Practice, 2023, 26(35): 4433-4438.
[2]	XIE Xuemei, GAO Jing, BAI Dingxi, LU Xianying, HE Jiali, LI Yue. Current Status of Polypharmacy in the Elderly and Its Influencing Factors: a Meta-analysis [J]. Chinese General Practice, 2023, 26(35): 4394-4403.
[3]	WANG Yue, CHEN Qing, LIU Lurong. Detection Rate of Depression and Its Influencing Factors in Chinese Elderly: a Meta-analysis [J]. Chinese General Practice, 2023, 26(34): 4329-4335.
[4]	LI Dianjiang, PAN Enchun, SUN Zhongming, WEN Jinbo, WANG Miaomiao, WU Ming, SHEN Chong. The Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community [J]. Chinese General Practice, 2023, 26(34): 4296-4301.
[5]	HAO Aihua, ZENG Weilin, LI Guanhai, XIA Yinghua, CHEN Liang. Current Situation of the Construction of Family Doctor Team: an Investigation Based on the Perspective of General Practitioners [J]. Chinese General Practice, 2023, 26(34): 4261-4268.
[6]	QIN Fengyin, ZHANG Qishan, LAI Jinjia, HUANG Yimin, HAN Guoyin, SUN Xinglan, WANG Fen, TAN Yibing. Current Status and Influencing Factors of the Intention to Screen for High-risk Stroke among Community Residents in Guangdong [J]. Chinese General Practice, 2023, 26(34): 4283-4289.
[7]	WANG Lina, GAO Pengfei, CAO Fan, GE Ying, YAN Wei, HE Daikun. Analysis of the Prevalence and Influencing Factors of Non-alcoholic Fatty Liver Disease in Different Gender Groups [J]. Chinese General Practice, 2023, 26(33): 4143-4151.
[8]	ZHANG Jin, DING Zhiguo, QI Shuo, LI Ying, LI Weiqiang, ZHANG Yuanyuan, ZHOU Tong. Relationship between Serum Thyroid Hormone Levels and Prognosis during Hospitalization in Heart Failure Patients [J]. Chinese General Practice, 2023, 26(33): 4125-4129.
[9]	ZHOU Yuyu, GAO Chuan, CUI Puan, WANG Yaping, HE Zhong. Influencing Factors of Shared Decision Making between Doctors and Patients in Menopausal Hormone Therapy in Patients with Menopausal Syndrome [J]. Chinese General Practice, 2023, 26(33): 4181-4186.
[10]	LIANG Xuan, NA Feiyang, QIN Mengyao, YANG Hui, GUO Li, GUO Qi, REN Lei, CHEN De, LIU Donghai, ZHANG Rongfang. Clinical Characteristics and Influencing Factors of Bronchial Asthma Combined with Obstructive Sleep Apnea-hypopnea Syndrome in Children [J]. Chinese General Practice, 2023, 26(33): 4225-4230.
[11]	LI Qianqian, CHEN Xunrui, ZHANG Wenying, YUAN Haihua, ZHANG Yanjie, JIANG Bin, LIU Feng. Demand and Influencing Factors for Community Health Services during Chemotherapy of Patients with Advanced Cancer [J]. Chinese General Practice, 2023, 26(33): 4173-4180.
[12]	WANG Yu, CHEN Yan, HAN Yuanyuan, XU Qing, CHEN Shengyue, LYU Zhibo, LU Chuan, ZHENG Mingxin, ZHAO Xin. Platelet-lymphocyte Ratio Predicts In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction [J]. Chinese General Practice, 2023, 26(33): 4137-4142.
[13]	ZHANG Juan, LI Haifen, LI Xiaoman, YAO Miao, MA Huizhen, MA Qiang. Construction of Recurrence Risk Prediction Model for Diabetic Foot Ulcer on the Basis of Logistic Regression, Support Vector Machine and BP Neural Network Model [J]. Chinese General Practice, 2023, 26(32): 4013-4019.
[14]	GAO Jing, ZHOU Shangcheng, GAO Sande, ZOU Guanyang, CHEN Yingyao. Health-related Quality of Life and Its Influencing Factors in Patients with Prevention of Disease in Traditionnal Chinese Medicine based on EQ-5D-5L Scale [J]. Chinese General Practice, 2023, 26(32): 4043-4050.
[15]	GAO Dekang, WEI Shaohua, MA Xiaoming, DU Peng, XING Chungen, CAO Chun. Risk Factors for Loss of Skeletal Muscle Mass and Its Correlation with Complications after Major Hepatectomy for Liver Cancer [J]. Chinese General Practice, 2023, 26(32): 4031-4037.