心脏术后再入ICU的临床特征及危险因素分析  

Analysis of clinical features and risk factors of re-admission to ICU after cardiac surgery

作　　者：陈未驰 赵研学 刘鑫裴 刘剑州 苗齐 郑军 张超纪 CHEN Weichi;ZHAO Yanxue;LIU Xinpei;LIU Jianzhou;MIAO Qi;ZHENG Jun;ZHANG Chaoji(Department of Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Cardiac Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院外科学系,北京100730 [2]中国医学科学院北京协和医院心脏外科,北京100730

出　　处：《中国医药导报》2023年第35期79-83,共5页China Medical Herald

基　　金：北京市科技计划项目(D171100002917001)。

摘　　要：目的 总结心脏术后再入重症监护室(ICU)患者的临床特征,评估术后再入ICU的危险因素。方法 北京协和医院心外科2016年1月至2022年12月入院进行心脏直视手术的患者共2 722例,术后进入ICU 2 102例,其中仅进入一次ICU 2 083例,再入ICU 19例。分析再入ICU的临床特征,并按1∶3配比在仅进入ICU一次的患者中选取和研究组年龄、性别、入院时间相似的57例作为对照组,通过条件logistic回归探索再入ICU的危险因素。结果 呼吸衰竭是心脏术后再入ICU的最主要原因。两组心功能分级、左室射血分数、体外循环时间、首次ICU停留时间、连续肾脏替代治疗比较,差异有统计学意义(P<0.05)。单因素条件logistic分析结果显示,术前心功能分级、左室射血分数、术中CPB时间、首次ICU停留时间、连续肾脏替代治疗与心脏术后再入ICU的发生有关(P<0.05)。多因素logistic回归结果显示,CRRT(OR:12.986,95%CI:2.839~59.395,P=0.001)是影响术后再入ICU的独立危险因素。结论 心脏直视术后行CRRT为心脏直视术后再入ICU的危险因素,其有助于帮助医生及时识别高危患者并促进诊疗。Objective To summarize the clinical characteristics of patients re-admission to the intensive care unit(ICU)after cardiac surgery and to evaluate the risk factors for re-admission to the ICU.Methods A total of 2722 patients admitted to the Department of Cardiac Surgery in Peking Union Medical College Hospital from January 2016 to December 2022 were admitted to ICU after open heart surgery,2102 patients were admitted to ICU after surgery,of which 2083 patients were admitted to ICU only once and 19 patients were re-admitted to ICU.The clinical characteristics of re-admission to ICU were analyzed,and 57 patients who were admitted to ICU only once were selected as the control group according to the ratio of 1∶3 and were similar in age,gender,and admission time to the study group.The risk factors of re-admission to ICU were explored by conditional logistic regression.Results Respiratory failure was the most important reason for re-admission to ICU after cardiac surgery.There were significant differences in cardiac function grade,left ventricular ejection fraction,cardiopulmonary bypass time,first ICU stay time,and continuous renal replacement therapy between the two groups(P<0.05).Univariate conditional logistic analysis showed that preoperative cardiac function grade,left ventricular ejection fraction,intraoperative CPB time,first ICU stay time,continuous renal replacement therapy were related to the occurrence of postoperative ICU re-admission(P<0.05).Multivariate logistic regression showed that CRRT(OR:12.986,95%CI:2.839-59.395,P=0.001)was an independent risk factor for postoperative re-admission to ICU.Conclusion CRRT after open heart surgery is a risk factor for re-admission to ICU after open heart surgery,which can help doctors identify high-risk patients in time and promote diagnosis and treatment.

关 键 词：心脏直视手术 重症监护室 再入重症监护室 危险因素 

分 类 号：R619[医药卫生—外科学]