心脏重症患者术后早期检验危急值与预后的相关性研究  

Correlation study between laboratory panic values of early postoperative period and prognosis in critical patients after cardiac surgery

作　　者：许欢[1] 洪亮[1] 陈尚瑜[1] 陈文秀[1] 宋晓春[1] 章淬[1] XU Huan;HONG Liang;CHEN Shang-yu;CHEN Wen-xiu;SONG Xiao-chun;ZHANG Cui(Department of ICU,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)重症医学科,江苏省南京市210006

出　　处：《中国心血管病研究》2022年第2期123-127,共5页Chinese Journal of Cardiovascular Research

基　　金：南京市卫生科技发展专项资金项目(ZKX19021)。

摘　　要：目的分析心脏重症患者术后早期检验危急值的发生与预后的相关性,评价现行的危急值项目对心脏重症患者预后的预测价值及其临床意义。方法采用回顾性队列研究的方法,从我院心脏重症临床数据库中收集2019年7月至2020年12月收治患者的临床资料,依据患者术后7 d内是否出现检验危急值报告分为危急值组和对照组,分析两组患者在住ICU时间和术后病死率的差异。进一步通过ROC曲线模型及术后28天生存分析,明确危急值报告对患者预后的预测价值并确定报告例次的最佳预测阈值。结果危急值组和对照组患者在住ICU时间[(8.28±9.59)d比(2.26±2.32)d]及术后病死率(21.98%比1.19%)方面存在显著差异,ROC曲线分析显示危急值报告模型对预后的预测价值高于APACHEⅡ评分模型[AUC:(0.748±0.052)比(0.684±0.044),P<0.05]。术后28 d生存分析进一步明确危急值报告模型下的最佳预测阈值为1例次(敏感度52.63%,特异度95.70%)。结论心脏重症患者术后早期发生1例次及以上的危急值报告,与患者延长住ICU时间及增加术后病死率存在相关性,可在一定程度上预测患者术后28天的病死率,具有显著的临床价值。Objective To analyze the relationship between the laboratory panic values of early postoperative period and prognosis in critical patients after cardiac surgery. Method The patients, whose clinical data were collected from the clinical database of cardiac intensive care in our hospital from July 2019 to December2020, were divided into the panic value group and the control group according to whether there were test panic value reports within 7 days after the operation;and the differences of ICU stay and postoperative mortality between the two groups were analyzed by a retrospective cohort study. Also the predictive value of panic value report on the prognosis of the patients and the best predictive threshold of reported cases were determined through ROC curve model and 28 days survival analysis after the operation. Results There were significant differences in ICU time [(8.28 ± 9.59)d vs.(2.26 ± 2.32)d] and mortality(21.98% vs. 1.19%) between the 2 groups. While the predictive value of panic value report model was higher than that of APACHEⅡ model [AUC:(0.748±0.052) vs.(0.684±0.044), P<0.05], shown in the ROC curve. The best predictive threshold of the panic value report was 1 case, confirmed by the 28 days survival analysis. Conclusion The panic value report of 1 case or more in the early postoperative period in critical patients after the cardiac surgery is related to the prolongation of ICU stay and the increase of postoperative mortality. It can predict the 28-day mortality after the operation to a certain extent,and has significant clinical value.

关 键 词：心脏重症 危急值 预测模型 

分 类 号：R654.2[医药卫生—外科学]