分析妇科恶性肿瘤患者术后急性心力衰竭（AHF）的发病情况及相关影响因素，以期预防并减少术后AHF发生，从而改善患者的治疗效果与预后。

回顾性分析2021年1月至2023年12月于河北医科大学第二医院住院并完成手术的妇科恶性肿瘤患者的临床资料，包括年龄、身体质量指数（BMI）、既往史、入院后辅助检查值：白细胞计数（WBC）、血红蛋白（HGB）、血小板（PLT）、D二聚体（D-dimer）、丙氨酸转氨酶（ALT）、总胆红素（TBil）、肌酐（Cr）、左室射血分数（LVEF）、手术时长、术中失血量、术后第1 d补液量、术后第1 d尿量等。根据术后至出院是否出现AHF分为心衰组和非心衰组，分析比较2组上述指标的统计学差异。

1049例患者中100例出现术后AHF，发病率为9.53%，其中宫颈癌患者的发病率为8.67%，卵巢癌患者的发病率为11.71%，子宫内膜癌患者发病率9.04%，其他妇科恶性肿瘤发病率为11.1%；心衰组和非心衰组在BMI、高血压、糖尿病、D-dimer、LVEF、手术时长、术中失血量、术后第1 d补液量等因素上差异均有统计学意义（P<0.05）；LVEF、手术时长和术后第1 d补液量是妇科恶性肿瘤术后发生急性心力衰竭的独立风险因素（P<0.05）；手术时长和术后第1 d补液量对应的ROC曲线下面积分别为0.657、0.730，截断值分别为4.25、2275。

AHF是妇科恶性肿瘤患者术后常见并发症，高BMI、糖尿病、高血压、高D-dimer、低LVEF、手术时长过长、术中出血量过大、术后第1 d补液量过多的妇科恶性肿瘤患者更易出现术后AHF，精准的术前评估，重视合并高BMI、高血压、糖尿病、高D-dimer、低LVEF患者管理，缩短手术时长、减少术中出血、调整术后补液量，能够降低AHF发生的风险，从而改善患者的治疗效果与预后。

To investigate the incidence and related influencing factors of postoperative acute heart failure in patients with gynecological malignant tumors, in order to prevent and reduce the occurrence of postoperative acute heart failure (AHF), thereby improving the therapeutic effect and prognosis of these patients.

A retrospective analysis was performed on the clinical data of gynecological malignant tumor patients who were hospitalized and underwent surgery at the Second Hospital of Hebei Medical University from January 2021 to December 2023, including age, body mass index (BMI), medical history, and auxiliary examination results after admission: white blood cell count (WBC), hemoglobin (HGB), platelet count (PLT), D-dimer, alanine aminotransferase (ALT), total bilirubin (TBil), creatinine (Cr), left ventricular ejection fraction (LVEF), surgical duration, intraoperative blood loss, postoperative day 1 fluid replacement volume, and postoperative day 1 urine volume. According to whether AHF occurred from postoperative to discharge, the patients were divided into an AHF group and a non-AHF group, and the differences in the above indicators between the two groups were compared.

Among the 1049 patients included, 100 had postoperative AHF, with an incidence rate of 9.53%. Specifically, the incidence rate of postoperative AHF was 8.67% for cervical cancer patients, 11.71% for ovarian cancer patients, 9.04% for endometrial cancer patients, and 11.1% for other gynecological malignant tumors. There were significant differences between the AHF group and the non-AHF group in BMI, hypertension, diabetes, D-dimer, LVEF, operation duration, intraoperative blood loss, and fluid replacement volume on the first day after operation (P<0.05). The duration of surgery and the amount of fluid replenished on the first day after surgery were identified to be independent risk factors for AHF after gynecological malignant tumor surgery (P<0.05). With respective cutoff values of 4.25 and 2275, the area under the ROC curve values of the duration of surgery and the amount of fluid replacement on the first day after surgery for predicting AHF were 0.657 and 0.730, respectively, with cutoff values of 4.25 and 2275.

AHF is a common postoperative complication in patients with gynecological malignancies. Patients with gynecological malignancies with a high BMI, diabetes, hypertension, high D-dimer, low LVEF, long operation time, excessive intraoperative blood loss, and excessive fluid replacement on the first day after operation tend to develop postoperative AHF. Accurate preoperative evaluation, paying attention to the management of patients with a high BMI, hypertension, diabetes, high D-dimer, and low LVEF, shortening the length of surgery, reducing intraoperative bleeding, and adjusting the amount of postoperative fluid replacement can reduce the risk of AHF, thus improving the therapeutic effect and prognosis of such patients.