| 杨 佳,刘晓辉,周文俊,黄园琴,左文霞.心脏外科术后重症患者死亡影响因素的Logistic回归分析及对预后的预测价值[J].,2022,(8):1529-1533 |
| 心脏外科术后重症患者死亡影响因素的Logistic回归分析及对预后的预测价值 |
| Logistic Regression Analysis of Influencing Factors of Death in Severe Patients after Cardiac Surgery and its Predictive Value for Prognosis |
| 投稿时间：2021-09-03 修订日期：2021-09-26 |
| DOI：10.13241/j.cnki.pmb.2022.08.027 |
| 中文关键词: 心脏外科手术 重症 危险因素 预后 预测价值 |
| 英文关键词: Cardiac surgery Severe Risk factors Prognosis Predictive value |
| 基金项目:湖北省卫生健康委2019年度第三批联合基金项目（WJ2019H341） |
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| 中文摘要: |
| 摘要 目的：探讨心脏外科术后重症患者死亡的影响因素并分析其对预后的预测价值。方法：回顾性分析2016年3月至2021年6月本院重症监护室（ICU）收治的108例心脏外科术后重症患者的临床资料，根据出院前临床结局分为死亡组及存活组，比较两组临床指标的差异，采用Logistic回归分析患者死亡的危险因素，绘制受试者特征工作曲线（ROC）分析危险因素对预后的预测价值。结果：108例患者存活组80例，死亡组28例；死亡组房颤史比例、Killip心功能分级≧III级比例、左室射血分数（LVEF）<40%比例、血管活性药物输注比例、急性生理学与慢性健康状况评分II（APACHEII）、心肌肌钙蛋白I（cTnI）、血肌酐（Scr）、B型钠尿肽（BNP）高于存活组，肾小球滤过率（eGFR）低于存活组，差异有统计学意义（P<0.05）；多因素Logistic回归分析显示，APACHEII评分、eGFR、cTnI是心脏外科术后重症患者死亡的独立危险因素（P<0.05）；ROC曲线显示，APACHEII评分、eGFR、cTnI预测心脏外科术后重症患者预后的曲线下面积分别为0.836、0.799、0.710，三者联合预测曲线下面积为0.862。结论：APACHEII评分、eGFR、cTnI是心脏外科术后重症患者预后的独立危险因素，三者联合用于预后的预测价值更高，可为临床治疗提供一定参考。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the influencing factors of death in severe patients after cardiac surgery and analyze its predictive value for prognosis. Methods: The clinical data of 108 critically ill patients after cardiac surgery who were treated in the intensive care unit (ICU) of our hospital from March 2016 to June 2021 were retrospectively analyzed. According to the clinical outcome before discharge, they were divided into death group and survival group. The differences of clinical indexes between the two groups were compared. The risk factors of death were analyzed by Logistic regression, and the subject characteristic working curve (ROC) was drawn to analyze the predictive value of risk factors on prognosis. Results: There were 80 cases in the survival group and 28 cases in the death group. The proportion of atrial fibrillation history, proportion of Killip cardiac function grade ≥grade III, proportion of left ventricular ejection fraction (LVEF) < 40%, proportion of vasoactive drug infusion, acute physiology and chronic health score II (APACHE II), cardiac troponin I (cTnI), serum creatinine (Scr) and B-type natriuretic peptide (BNP) in the death group were higher than those in the survival group, and the glomerular filtration rate (eGFR) was lower than those in the survival group, the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that APACHE II score, eGFR and cTnI were independent risk factors for death of severe patients after cardiac surgery(P<0.05). ROC curve showed that the areas under curve of APACHE II score, eGFR and cTnI predicting the prognosis of severe patients after cardiac surgery were 0.836, 0.799 and 0.710 respectively, and the area under curve predicted by the combination of the three was 0.862. Conclusion: APACHE II score, eGFR and cTnI are independent risk factors for the prognosis of severe patients after cardiac surgery. The combination of the three has higher prognostic value and can provide some reference for clinical treatment. |
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