感染性心内膜炎患者外科术后发生ICU时间延长的危险因素  

Risk factors for prolonged ICU stay after surgery in patients with infective endocarditis

作　　者：汤黎黎 黎学明 雷黎明 曾晓东 凌云 林琼瑜[1] 朱苏敏 TANG Lili;LI Xueming;LEI Liming;ZENG Xiaodong;LING Yun;LIN Qiongyu;ZHU Sumin(Department of Cardiac Surgery Intensive Care Unit,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Science),Southern Medical University,Guangzhou 510080,Guangdong,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院),广东省心血管病研究所心外科重症监护一科,广东广州510080

出　　处：《实用医学杂志》2024年第20期2854-2859,共6页The Journal of Practical Medicine

基　　金：广东省医学科研基金项目(编号:A2021486);广东省人民医院(广东省医学科学院)循证护理实践项目(编号:DFJH2021028)。

摘　　要：目的分析感染性心内膜炎(infectious endocarditis,IE)术后发生ICU时间延长的危险因素,为预防IE术后住ICU时间延长提供依据。方法选取2019年1月1日至2021年3月31日在广东省人民医院心脏外科进行手术治疗的感染性心内膜炎患者,总共纳入223例患者。按照术后ICU停留时间是否大于3 d分为非延长组(<3 d)和延长组(≥3 d)。非延长组156例,延长组67例。ICU时间延长危险因素的单因素分析采用t检验或秩和检验,单因素分析中P<0.05的变量再进行二分类logistic回归多因素分析。采用ROC曲线评估模型的精确度。结果223例患者中共67例患者发生ICU时间延长,发生率30%。单因素分析结果:性别、年龄、冠心病史、脑梗死史、术前心衰、主动脉瓣返流面积、左室舒张末径、左室射血分数LVEF<60%、体外循环时间、主动脉阻断时间、使用IABP、气管插管重插管、肺部感染、使用CRRT、机械通气时间延长>24 h等。多因素分析结果显示术前左室射血分数LVEF<60%(OR=3.004,P=0.041)、术后使用IABP(OR=31.686,P=0.008)以及机械通气时间>24 h(OR=8.135,P<0.001)为IE术后ICU时间延长的独立危险因素。该模型预测ICU时间延长危险因素的AUC值为0.858(95%CI:0.806~0.901,P<0.001)。结论术前左室射血分数LVEF<60%、使用IABP以及机械通气时间>24 h是为IE术后ICU时间延长独立危险因素,临床工作中要综合防治各种危险因素,以期缩短ICU停留时间、提高手术成功率。Objective Analyzing risk factors for prolonged ICU stay after cardiac surgery of Infective Endocarditis(IE)provides a basis for preventing extended ICU durations in postoperative IE cases.Methods From January 1,2019,to March 31,2021,a total of 223 patients with infective endocarditis who underwent cardiac surgery in the cardiac surgery department of Guangdong Provincial People's Hospital were included.Patients were divided into non-prolonged group(<3 days)and prolonged group(≥3 days)based on postoperative ICU stay duration.There were 156 cases in the non-prolonged group and 67 cases in the prolonged group.Single-factor analysis of risk factors for prolonged ICU stay was conducted using t-tests or rank-sum tests.Variables with P<0.05 in the single-factor analysis were further subjected to binary logistic regression for multivariate analysis.The accuracy of the model was evaluated using the ROC curve.Results Among the 223 patients,67 experienced prolonged ICU stay,with an incidence rate of 30%.Single-factor analysis results included gender,age,history of coronary heart disease,history of stroke,preoperative heart failure,aortic valve regurgitation area,left ventricular end-diastolic diameter,left ventricular ejection fraction(LVEF)<60%,extracorporeal circulation time,aortic cross-clamp time,use of Intra-Aortic Balloon Pump(IABP),endotracheal tube reintubation,pulmonary infection,use of Continuous Renal Replacement Therapy(CRRT),and prolonged mechanical ventilation time(>24 hours),among others.Multivariate analysis results revealed that preoperative LVEF<60%(OR=3.004,P=0.041),postoperative use of IABP(OR=31.686,P=0.008),and mechanical ventilation time>24 hours(OR=8.135,P<0.001)were independent risk factors for prolonged ICU stay after cardiac surgery.The model's AUC value for predicting risk factors for prolonged ICU stay was 0.858(95%CI:0.806~0.901,P<0.001).Conclusion Preoperative left ventricular ejection fraction(LVEF)<60%,the use of IABP,and mechanical ventilation time>24 hours were identified as independent r

关 键 词：感染性心内膜炎 心脏外科手术 ICU时间延长 危险因素 

分 类 号：R619.9[医药卫生—外科学]