StanfordA型主动脉夹层术后重度低氧血症风险预测模型的探索  

A prediction model for severe postoperative hypoxemia after surgery for Standford type A aortic dissection

作　　者：鞠帆[1] 刘楠[1] 潘旭东[1] 乔环宇[1] 李论[1] 戎天华 孙立忠[1] 郑斯宏[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所北京市大血管疾病诊疗中心,100029

出　　处：《中华医学杂志》2016年第13期1001-1006,共6页National Medical Journal of China

基　　金：国家卫生和计划生育委员会公益性行业科研专项（201402009）;重点医学专业发展“扬帆”计划（ZXLX201503）

摘　　要：目的研究StanfordA型主动脉夹层术后重度低氧血症出现的独立危险因素，并建立相应的风险预测模型。方法回顾性分析北京安贞医院心脏外科2014年1月至2015年4月连续收治的411例StanfordA型主动脉夹层患者临床资料，根据患者术后是否出现重度低氧血症将其分为重度低氧组及非重度低氧组，并将危险因素指标录入数据库，数据纳入logistic回归方程，利用得到的独立危险因素建立预测模型，并用ROC曲线以及Hosmer—Lemeshow拟合优度检验对模型进行评价。结果围手术期死亡率5．57％（27／411），术后48h内重度低氧血症[动脉血氧分压／吸入氧浓度（Pa02／Fi02）≤100mmHg]共69例，发生率为17．1％。多因素logistic回归提示体质指数、年龄、术前肌红蛋白水平、术中体外循环时间、术前丙氨酸转氨酶水平、术后48h内二次开胸手术、术前血肌酐为重度低氧的独立危险因素，并据此建立预测模型。预测模型ROC曲线下面积（AUC）=0．785，Hosmer-Lemeshow拟合优度检验P=0．625。结论本研究建立的logistic模型能够成功预测StanfordA型主动脉夹层术后重度低氧血症的发生风险，预测效能满意。Objective To study the risk factors of severe postoperative hypoxemia after surgery for Standford type A aortic dissection and establish a prediction model. Methods Data of 411 consecutive patients from January 2014 to April 2015, who underwent surgery for Standford type A aortic dissection in the department of cardiovascular surgery of Beijing Anzhen Hospital, were retrospectively analyzed. All the cases were divided into two groups according to the appearance of severe postoperative hypoxemia. All the data about potential risk factors was put into the database and analyzed by logistic regression. The prediction model was then established upon acquired independent risk factors. Discrimination and calibration of the prediction model were assessed with ROC curve and Hosmer and Lemeshow goodness of fit test. Results The perioperative in-hospital mortality was 6. 57% （ 27/411 ）. Severe postoperative hypoxemia （ PaO2/FiO2 ≤ 100 mmHg） happened in 69 cases within 48 hours after procedures, with an incidence rate of 17.1%. The logistic regression demonstrated that body mass index （BMI）, age, preoperative serum myoglobin, preoperative serum creatinine, preoperative serumalanirle aminotransferase, the time of cardiopulmonary bypass, re-exploration within 48 hours after procedures were the independent risk factors for severe postoperative hypoxemia. The prediction model was then established based on these independent risk factors. The area under ROC curve of the model was 0. 785, and the P value in Hosmer and Lemeshow goodness of fit test was 0. 625. Conclusion The logsitic model built in this study succeeded to predict the incidence of severe postoperative hypoxemia after surgery for Standford type A aortic dissection, and it could meet the doctors＇ requirement with its excellent discrimination and calibration.

关 键 词：主动脉夹层 术后低氧血症 危险因素 预测模型 

分 类 号：R654.2[医药卫生—外科学]