局部氧饱和度监测对老年急性下肢缺血患者再通术后临床结局的预测价值及列线图模型的构建  

Prediction value of regional oxygen saturation monitoring on clinical outcome after revascularization in elderly patients with acute lower limb ischemia and construction of a nomogram model

作　　者：郭仁楠 李婷[2] 杨建平[3] 王凯阳 刘艳[1] Guo Rennan;Li Ting;Yang Jianping;Wang Kaiyang;Liu Yan(Department of Intensive Care Medicine,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830000,Xinjiang Uygur Autonomous Region,China;Department of Anesthesiology,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830000,Xinjiang Uygur Autonomous Region,China;Department of Vascular Surgery,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830000,Xinjiang Uygur Autonomous Region,China;Department of Cardiology,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830000,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆维吾尔自治区人民医院重症医学科,新疆维吾尔自治区乌鲁木齐830000 [2]新疆维吾尔自治区人民医院麻醉科,新疆维吾尔自治区乌鲁木齐830000 [3]新疆维吾尔自治区人民医院血管外科,新疆维吾尔自治区乌鲁木齐830000 [4]新疆维吾尔自治区人民医院心内科,新疆维吾尔自治区乌鲁木齐830000

出　　处：《中国中西医结合急救杂志》2023年第4期458-463,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：新疆维吾尔自治区“青年科技人才-乡村振兴”项目(WJWY-XCZ-X202202)。

摘　　要：目的探讨局部氧饱和度(rSO2)水平对老年急性下肢缺血(ALLI)患者再通术后临床结局的预测价值,并建立列线图预测模型。方法回顾性分析2021年1月至2022年12月新疆维吾尔自治区人民医院重症医学科收治的86例老年ALLI再通术后患者的临床资料,包括性别、年龄、合并症(高血压、糖尿病、冠心病、血脂异常、心房颤动)、脑卒中史、吸烟史、卢瑟福分级、踝肱指数、干预时间>12 h、药物使用情况(低分子肝素、罂粟碱、前列地尔)、rSO2(24 h值)和实验室检查结果〔白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)、C-反应蛋白(CRP)、血乳酸(Lac)、肌酸激酶(CK)、肌红蛋白(Mb)、心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)〕。根据是否发生不良事件将患者分为发生不良事件组和未发生不良事件组,比较两组患者上述指标的差异。采用多因素Logistic回归分析筛选影响不良事件发生的独立危险因素,绘制受试者工作特征曲线(ROC曲线)评估各因素对不良预后的预测价值,进一步构建列线图预测模型,采用决策曲线分析法(DCA)评价预测模型的适用性及实际效益。结果共86例ALLI患者纳入研究,再通术后不良事件发生率为26.7%(23例)。发生不良事件组患者术后第6、12、18、24 h(1st、2nd、3rd、4th 6 h)4个阶段rSO2和24 h平均rSO2以及踝肱指数均明显低于未发生不良事件组,而cTnI、cTnT、Mb、CK和Lac水平均明显高于未发生不良事件组(均P<0.05)。多因素Logistic回归分析显示:24 h平均rSO2〔优势比(OR)=0.681,95%可信区间(95%CI)为0.531~0.873,P=0.002〕和踝肱指数(OR=0.002,95%CI为0.000~0.661,P=0.030)降低均是ALLI患者发生不良预后的独立保护因素,而Mb(OR=1.006,95%CI为1.001~1.011,P=0.029)和CK(OR=1.004,95%CI为1.000~1.007,P=0.025)升高是ALLI患者发生不良预后的独立危险因素;ROC曲线分析显示:24 h平均rSO2,Mb、CK和踝肱指数对患者不Objective To explore the predictive value of regional oxygen saturation(rSO2)level for clinical outcome after revascularization in elderly patients with acute lower limb ischemia(ALLI)and establish a nomogram model.Methods Retrospective analysis of clinical data of 86 elderly ALLI patients admitted to the department of intensive care medicine of Xinjiang Uygur Autonomous Region People's Hospital from January 2021 to December 2022,including gender,age,complications(hypertension,diabetes,coronary heart disease,dyslipidemia,atrial fibrillation),stroke history,smoking history,Rutherford classification,ankle-brachial index,intervention time>12,drug use(low molecular weight heparin,papaverine,alprostadil),rSO2(24 hours value)and laboratory results[white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),C-reactive protein(CRP),blood lactic acid(Lac),creatine kinase(CK),myoglobin(Mb),cardiac troponin I(cTnI)and cardiac troponin T(cTnT)].According to the occurrence of adverse events,the patients were divided into the event group and the non-event group.The difference between the event group and the non-event group was compared in terms of the above indicators.Multivariate Logistic regression analysis was used to determine the independent risk factors of adverse events,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for adverse events.A nomogram prediction model was further constructed,and the applicability and practical benefit of the prediction model were evaluated by decision curve analysis(DCA).Results A total of 86 ALLI patients were included in this study,and the incidence of adverse events after revascularization was 26.7%(23 cases).Event group patients 4 stages:6th,12th,18th,24th hour(1st,2nd,3rd,4th 6 hours)rSO2,24 hours average rSO2 values,and ankle brachial index were significantly lower than the event group,while cTnI,cTnT,Mb,CK and Lac levels were significantly higher than the event group(all P<0.05).Multiv

关 键 词：局部氧饱和度 近红外光谱法 急性下肢缺血 列线图模型 不良预后 

分 类 号：R459.7[医药卫生—急诊医学] R563.1[医药卫生—治疗学]