急性肺栓塞合并右心功能不全患者进入重症监护室的相关危险因素分析及风险预测  

Analysis of risk factors and risk prediction for intensive care unit admission in patients with acute pulmonary embolism combined with right ventricular dysfunction

作　　者：付春[1] 朱凤雪[1] 陈源源[2] 李纾[1] 赵秀娟[1] 姜娟[3] 王振洲 刘健[4] Fu Chun;Zhu Fengxue;Chen Yuanyuan;Li Shu;Zhao Xiujuan;Jiang Juan;Wang Zhenzhou;Liu Jian(Department of Intensive Care Unit,Peking University People s Hospital,Beijing 100044,China;Department of Hypertension,Peking University People s Hospital,Beijing 100044,China;Department of Geriatrics,Peking University People s Hospital,Beijing 100044,China;Cardiovascular Department of the Heart Center,Peking University People s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院重症医学科,100044 [2]北京大学人民医院高血压科,100044 [3]北京大学人民医院老年科,100044 [4]北京大学人民医院心血管内科,100044

出　　处：《中国心血管杂志》2025年第1期45-51,共7页Chinese Journal of Cardiovascular Medicine

基　　金：北京市自然科学基金(7222199)。

摘　　要：目的探讨中、高危急性肺栓塞(APE)合并右心功能不全(RVD)患者的临床特征,分析他们进入重症监护室(ICU)的独立危险因素并建立风险预测模型。方法单中心、回顾性研究。连续纳入2012年12月至2022年12月于北京大学人民医院经CT肺动脉造影(CTPA)确诊为中、高危APE合并RVD的住院患者共92例,其中男性42例、女性50例,平均年龄(67.3±10.9)岁。根据是否收治ICU分为入ICU组(31例)和未入ICU组(61例),收集两组患者的一般资料、临床特征、生化检查和影像学指标。多因素logistic回归分析影响APE合并RVD患者进入ICU的独立危险因素,并建立风险预测模型。采用受试者工作特征(ROC)曲线评价相关指标对APE合并RVD患者进入ICU的预测价值,ROC曲线下面积(AUC)评价模型的预测准确性。结果与未入ICU组比较,入ICU组患者的心率和呼吸频率较快、收缩压(SBP)和舒张压(DBP)较低,心功能指标中B型利钠肽(BNP)、高敏肌钙蛋白I(hs-cTnI)和肺动脉收缩压(PASP)较高以及左心室射血分数(LVEF)较低,凝血功能指标中D-二聚体(D-dimer)较高,合并创伤/骨折病史比例较高(均为P<0.05)。多因素logistic回归分析显示,SBP、BNP、hs-cTnI、PASP和D-dimer是影响APE合并RVD患者进入ICU的独立危险因素(均为P<0.05)。ROC曲线分析显示,当APE合并RVD患者的SBP>119 mmHg(AUC=0.879,95%CI:0.811~0.947)时进入ICU可能性降低,BNP>416 pg/ml(AUC=0.996,95%CI:0.988~1.000)、hs-cTnI>321.15 pg/ml(AUC=0.801,95%CI:0.694~0.907)、D-dimer>686 ng/ml(AUC=0.852,95%CI:0.771~0.933)和PASP>41 mmHg(AUC=0.967,95%CI:0.905~1.000)时进入ICU可能性增加(均为P<0.001)。根据上述指标是否为高优或低优指标进行赋值,并建立风险预测模型,即Score1模型(取值范围[0,5]),截断点值为3分(AUC=0.999,95%CI:0.996~1.000,P<0.001),即当APE合并RVD患者的Score1≤3分时,患者进入ICU的可能性增加;当APE合并RVD患者的Score1>3分时,患者进入ICU的可能性降低。结论SBP、Objective To explore the clinical characteristics and risk factors for admission to intensive care unit(ICU)in patients with moderate to high-risk acute pulmonary embolism(APE)combined with right ventricular dysfunction(RVD).Methods Single center,retrospective study.A total of 92 hospitalized patients diagnosed with moderate to high-risk APE combined with RVD by CT pulmonary angiography(CTPA)at Peking University People s Hospital from December 2012 to December 2022 were included,including 42 males and 50 females,with a mean age of 67.3±10.9 years.The patients were divided into the ICU admission group(31 cases)and the non ICU admission group(61 cases).General information,clinical characteristics,biochemical tests,and imaging indicators of the two groups of patients were collected.Multivariate logistic regression analysis was conducted to identify independent risk factors for APE combined with RVD patients entering the ICU,and a risk prediction model was established.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of relevant indicators for APE combined with RVD patients entering the ICU,and the area under the ROC curve(AUC)was used to evaluate the predictive accuracy of the model.Results Compared with non ICU group,patients in ICU group had faster heart rate and respiratory rate,lower systolic blood pressure(SBP)and diastolic blood pressure(DBP),higher levels of brain natriuretic peptide(BNP),high-sensitivity troponin I(hs-cTnI),and pulmonary artery systolic pressure(PASP),lower left ventricular ejection fraction(LVEF),higher level of D-dimer in coagulation function indicators,and a higher proportion of patients with a history of trauma/fracture(all P<0.05).Multivariate logistic regression analysis showed that SBP,BNP,hs-cTnI,PASP,and D-dimer were independent risk factors for ICU admission in patients with APE and RVD(all P<0.05).ROC curve analysis showed that when SBP>119 mmHg(AUC=0.879,95%CI:0.811-0.947),the likelihood of admission to the ICU decreased,while when BNP>416

关 键 词：急性肺栓塞 右心功能不全 重症监护室 危险因素 预测模型 

分 类 号：R563.5[医药卫生—呼吸系统]