心脏移植术后早期血肌钙蛋白水平变化及院内死亡影响因素分析  

Changes of serum troponin levels and influencing factors of hospital death in early stage after heart transplantation

作　　者：李敏[1] 王慧华 李燕君 LI Min;WANG Huihua;LI Yanjun(Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei 430022 China)

机构地区：[1]华中科技大学同济医学院附属协和医院

出　　处：《护理研究》2020年第5期789-794,共6页Chinese Nursing Research

基　　金：湖北省自然科学基金项目，编号：2014CFB997

摘　　要：[目的]探讨心脏移植术后早期血肌钙蛋白(TnI)水平变化及其与院内死亡的关系。[方法]选取2013年4月—2018年1月我院收治的进行心脏移植的病人520例作为研究对象,采用ROC曲线分析手术当天(术后入重症监护室1 h内抽血化验)至手术第2天血TnI水平对心脏移植术后病人院内死亡预测作用并寻找阈值,根据阈值将病人分为高TnI水平组和低TnI水平组,然后比较两组的术前一般资料、术后恢复情况以及院内死亡率,并采用Logistic回归分析心脏移植术后病人发生院内死亡的独立危险因素。[结果]术后第1天TnI水平预测院内死亡ROC曲线下面积为0.888[95%CI(0.799~0.976),P<0.05],当TnI水平为38.5 ng/mL时,预测院内死亡的敏感性和特异性分别为82.1%和92.7%;以38.5 ng/mL为临界值,将纳入病人分为高TnI水平组(TnI≥38.5 ng/mL)和低TnI水平组(TnI<38.5 ng/mL);两组病人受体术前肌酐、术前NT‐proBNP升高倍数、供体体重、供体冷却血时间、供体冷却血时间≥6 h所占比例差异具有统计学意义(P<0.05);520例心脏移植者中,院内死亡的病人有27例,其中高TnI水平组院内死亡13例,低TnI水平组院内死亡14例;高TnI水平组院内死亡率明显高于低TnI水平组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前血肌酐[OR=2.15,95%CI(1.31~3.43)]、术前血胆红素[OR=3.63,95%CI(1.55~8.79)]、术后第1天TnI水平[OR=4.26,95%CI(1.07~5.36)]是影响心脏移植术后院内死亡的危险因素。[结论]心脏移植病人早期TnI水平升高与受体、供体等因素有关,术前血肌酐、术前血胆红素、术后第1天TnI水平(≥38.5 ng/mL)是院内死亡的危险因素。Objective:To investigate the changes of serum troponin level in early stage after heart transplantation and analyse its relationship with hospital death.Methods:A total of 520 patients with cardiac transplantation admitted to our hospital from April 2013 to January 2018 were selected as the research objects.ROC curve was used to analyze the predictive effect of troponin I(TnI)level on the in-hospital death of cardiac transplant patients from the day of surgery(blood test within 1 hour after admission to the intensive care unit)to the second day of surgery and the threshold was analyzed.Patients were divided into two groups according to the threshold,high TnI level group and low TnI level group.Then the general preoperative data,postoperative recovery and in-hospital mortality of the two groups were compared.Logistic regression analysis was used to analyze the independent risk factors of in-hospital mortality of heart transplant patients.Results:The area under ROC curve for predicting in-hospital death at TnI level on the first day after operation was 0.888[95%CI(0.799‐0.976),P<0.05].When TnI level was 38.5 ng/mL,the sensitivity and specificity for predicting in-hospital death was 82.1%and 92.7%,respectively.With 38.5 ng/mL as the critical value,the patients included in the study were divided into high TnI level group(TnI≥38.5 ng/mL)and low TnI level group(TnI<38.5 ng/ml).The proportions of preoperative creatinine,preoperative NT‐proBNP elevation degree,donor body weight,donor cooling blood time and donor cooling blood time≥6 h in the two groups were statistically significant(P<0.05).Among 520 heart transplanters,27 patients suffered from in-hospital death,including 13 patients with high TnI level,and 14 patients with low TnI level.The in-hospital death rate of high TnI level group was significantly higher than that of low TnI level group,the difference was statistically significant(P<0.05).The multivariate Logistic regression analysis showed that preoperative serum creatinine[OR=2.15,95%CI(1.31‐3.43)],p

关 键 词：心脏移植 血肌钙蛋白I 院内死亡 影响因素 供体 受体 预测 

分 类 号：R473.6[医药卫生—护理学]