老年胆道疾病患者围术期主要心脏不良事件监测指标探讨  

Exploration of critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases

作　　者：张宗明 谢希源 林方才 赵月 张翀 刘卓 刘立民 朱明文 万柏江 邓海 田坤 郭震天 Zhang Zongming;Xie Xiyuan;Lin Fangcai;Zhao Yue;Zhang Chong;Liu Zhuo;Liu Limin;Zhu Mingwen;Wan Baijiang;Deng Hai;Tian Kun;Guo Zhentian(Department of General Surgery,Beijing Electric Power Hospital,State Grid Corporation of China,Capital Medical University,Beijing 100073,China)

机构地区：[1]国家电网公司北京电力医院普外科,北京100073

出　　处：《中华老年医学杂志》2023年第2期159-164,共6页Chinese Journal of Geriatrics

基　　金：北京市科技重大专项生物医药与生命科学创新培育研究(Z171100000417056)。

摘　　要：目的探讨老年胆道疾病患者围术期主要心脏不良事件(MACE)监测指标,以期及时采取有效防治措施、维持围术期心功能稳定、提高围术期安全保障。方法收集2016年5月至2022年2月北京电力医院普外科收治的老年胆道疾病手术患者246例临床资料,根据患者围术期是否发生MACE分为MACE组和非MACE组,对比分析两组患者临床资料、术后心功能和凝血功能监测指标。应用Logistic回归分析围术期MACE的独立危险因素,计算其ROC曲线危急值,并建立Logistics多因素预测模型。结果MACE组较非MACE组患者年龄更大、术后并发症增多、病死率升高、术后住院天数增加(均P<0.05),术后高敏肌钙蛋白-I(Hs-TnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、B-型钠酸肽(BNP)、D-二聚体(D-D)显著升高(均P<0.05)。多因素Logistic回归提示术后BNP、D-D为围术期MACE的两项独立危险因素,二者在ROC曲线的截断值分别为382.65 pg/ml和0.975 mg/L。Logistic多因素预测模型为P=e^(x)/(1+e^(x)),X=-5.710+0.003X_(1)+0.811X_(2),X_(1)为患者术后BNP水平,X2为患者术后D-D水平,该模型预测围术期MACE的准确度为96.3%(237/246)、特异度为100.0%(235/235)、敏感度为18.2%(2/11)。结论本研究建立的Logistic多因素预测模型能够有效预测老年胆道疾病患者围术期MACE发生,术后BNP和D-D是围术期MACE的两项独立危险因素,二者可以作为围术期MACE监测指标的危急值,据此及时采取有效防治措施,对于维护围术期心功能稳定,从而进一步提高老年胆道疾病患者围术期安全保障,具有十分重要的临床指导意义。Objective The purpose of this study was to explore the critical values of monitored indexes of perioperative major adverse cardiac events(MACE),so as to take effective prevention and treatment measures in time to maintain the stability of perioperative cardiac function to further improve the perioperative safety of elderly patients with biliary diseases.Methods The clinical data of 246 elderly patients with biliary diseases in our hospital from May 2016 to February 2022 were collected.According to whether MACE occurred during the perioperative period,they were divided into the MACE group and the non-MACE group.The differences of clinical data,the monitoring indexes of postoperative cardiac function,and the coagulation function between the two groups were compared and analyzed.Logistic regression was used to analyze the independent risk factors of perioperative MACE,the cut-off value of the receiver operating characteristic(ROC)curve was calculated,and the Logistic multivariate prediction model was established.Results In the MACE compared with the non-MACE group,age,postoperative complications and mortality,postoperative hospital stay,and the levels of postoperative high sensitivity troponin-I(Hs-TnI),creatine kinase isoenzyme(CK-MB),myoglobin(MYO),B-type natriuretic peptide(BNP),and D-dimer(D-D)were significantly increased(all P<0.05).Multivariate Logistic regression showed that postoperative BNP and D-D were two independent risk factors for perioperative MACE,and their cut-off values in the ROC curve were 382.65 pg/mL and 0.975mg/L respectively.The Logistic multivariate prediction model established by the Logistic regression equation was P=e^(x)/(1+e^(x)),X=-5.710+0.003X1+0.811X_(2),where X_(1) was the postoperative BNP level and X_(2) was the postoperative D-D level.The accuracy,specificity and sensitivity of this prediction model for predicting perioperative MACE were 96.3%(237/246),100.0%(235/235),and 18.2%(2/11).Conclusions The Logistic multivariate prediction model established in this study can effectively

关 键 词：胆道疾病 手术期间 心脏不良事件 

分 类 号：R575[医药卫生—消化系统]