心外科围手术期应激性心肌病患者死亡的危险因素分析OA
Analysis of risk factors for mortality in patients with perioperative stress cardiomyopathy undergoing cardiac surgery
目的 探讨心外科围手术期应激性心肌病患者死亡的危险因素.方法 回顾性收集心外科围手术期应激性心肌病患者146 例的临床资料,其中,存活组 102 例,死亡组 44 例.比较两组患者一般资料、手术类型、血液指标、并发症、心功能指标等,并采用Logistic回归分析探讨应激性心肌病患者死亡的危险因素.结果 在纳入的 146 例应激性心肌病患者中,总体死亡率为30.14%;存活组与死亡组间心功能分级、术前焦虑、术前使用血管活性药物、术后并发恶性心律失常、术后并发血栓形成与栓塞、术后二次开胸、术后再插管、术后左心室舒张末期内径(LVEDD)、术后左心室射血分数(LVEF)、术后C反应蛋白(CRP)、术后肌酐、术后心肌肌钙蛋白 I(cTnI)、术后肌酸激酶同工酶(CK-MB)、术后 N 末端 B 型利钠肽原(NT-proBNP)、呼吸机使用时间的差异均有统计学意义(均P<0.05).将以上因素纳入二分类Logistic回归分析,结果显示术后肌酐[OR(95%CI):1.060(1.006～1.117),P=0.028]、术后NT-proBNP[OR(95%CI):1.003(1.001～1.005),P=0.007]、呼吸机使用时间[OR(95%CI):1.882(1.140～3.107),P=0.014]是心外科围手术期应激性心肌病危重症患者死亡的独立影响因素.ROC曲线分析显示,肌酐、呼吸机使用时间、NT-proBNP 三项指标联合预测的曲线下面积(AUC)为0.866(95%CI 0.792～0.940),优于单一指标;联合检测的敏感性为0.864,特异性为0.269.DeLong检验显示,三项指标联合预测的 AUC 显著高于肌酐(Z=2.841,P=0.005)、NT-proBNP(Z=3.670,P<0.001)、呼吸机使用时间(Z=4.920,P<0.001).结论 术后肌酐、NT-proBNP、呼吸机使用时间是心外科围手术期应激性心肌病患者死亡的独立影响因素,三者联合检测对死亡风险具有较高的预测价值.
Objective To investigate the risk factors for mortality in patients with perioperative stress cardiomyopathy undergoing cardiac surgery.Methods Clinical data of 146 patients with perioperative stress cardiomyopathy undergoing cardiac surgery were retrospectively collected,including 102 patients in a survival group and 44 patients in a death group.General data,surgical types,blood indicators,complications,and cardiac function parameters were compared between the two groups.Logistic regression analysis was used to explore the risk factors for mortality in these patients.Results Among the enrolled 146 patients with stress cardiomyopathy,the overall mortality rate was 30.14%.Statistically significant differences were observed between the survival and death groups in cardiac function classification,preoperative anxiety,preoperative use of vasoactive drugs,postoperative malignant arrhythmia,postoperative thrombosis formation and embolism,postoperative re-sternotomy,postoperative re-intubation,postoperative left ventricular end-diastolic diameter(LVEDD),postoperative left ventricular ejection fraction(LVEF),postoperative C-reactive protein(CRP),postoperative creatinine,postoperative cardiac troponin I(cTnI),postoperative creatine kinase-MB(CK-MB),postoperative N-terminal pro-B-type natriuretic peptide(NT-proBNP),and duration of mechanical ventilation(all P<0.05).Binary Logistic regression analysis incorporating the above factors revealed that postoperative creatinine[OR(95%CI):1.060(1.006-1.117),P=0.028],postoperative NT-proBNP[OR(95%CI):1.003(1.001-1.005),P=0.007],and duration of mechanical ventilation[OR(95%CI):1.882(1.140-3.107),P=0.014]were independent risk factors for mortality in critically ill patients with perioperative stress cardiomyopathy undergoing cardiac surgery.ROC curve analysis showed that the area under the curve(AUC)for the combined prediction of creatinine,duration of mechanical ventilation,and NT-proBNP was 0.866(95%CI 0.792-0.940),which was superior to any single indicator.The sensitivity of the combined detection was 0.864,and specificity was 0.269.DeLong test indicated that the AUC of the combined prediction was significantly higher than that of creatinine(Z=2.841,P=0.005),NT-proBNP(Z=3.670,P<0.001),and duration of mechanical ventilation(Z=4.920,P<0.001).Conclusion Postoperative creatinine,NT-proBNP,and duration of mechanical ventilation are independent risk factors for mortality in patients with perioperative stress cardiomyopathy undergoing cardiac surgery.The combined detection of these three indicators has high predictive value for mortality risk.
贺欢;杨静;马兰;马琴;马晶
830054 新疆 乌鲁木齐,新疆医科大学第一附属医院重症医学二科830054 新疆 乌鲁木齐,新疆医科大学第一附属医院重症医学二科830054 新疆 乌鲁木齐,新疆医科大学第一附属医院重症医学二科830054 新疆 乌鲁木齐,新疆医科大学第一附属医院重症医学二科830054 新疆 乌鲁木齐,新疆医科大学第一附属医院重症医学二科
医药卫生
心外科手术围手术期应激性心肌病死亡危险因素
cardiac surgeryperioperative periodstress cardiomyopathymortalityrisk factor
《实用心电与临床诊疗》 2026 (1)
59-64,71,7
评论