心肌酶谱联合急性生理学和慢性健康状况评价Ⅱ评分对急性下肢缺血手术结局的预测价值  

Predictive value of surgical outcomes for acute lower extremity ischemia using myocardial enzyme spectrum combined with acute physiology and chronic health evaluationⅡscore

作　　者：刘明阳 杨志勇 刘琳 Liu Mingyang;Yang Zhiyong;Liu Lin(Department of Vascular Surgery,the First Hospital of Zhangjiakou,Zhangjiakou 075000,Hebei,China)

机构地区：[1]张家口市第一医院血管外科,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2025年第3期413-418,共6页Journal of Vascular and Endovascular Surgery

基　　金：河北省卫生健康委科研基金项目(20232070)。

摘　　要：目的探讨心肌酶谱联合急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分对急性下肢缺血手术结局的预测价值。方法收集2018年1月至2022年12月于张家口市第一医院接受手术治疗的173例急性下肢缺血患者的临床资料,将获得良好手术结局的124例患者作为良好组,将获得不良手术结局的49例患者作为不良组。比较两组患者的一般指标、病因、术前指标[缺血时间、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、钠(Na)水平、钾(K)水平、肌酐水平、血细胞比容、白细胞计数(WBC)、APACHEⅡ评分、肌红蛋白(MB)水平、肌酸激酶(CK)水平、肌酸激酶同工酶(CK-MB)水平、肌钙蛋白T(cTnT)水平、乳酸脱氢酶(LDH)水平、B型钠尿肽(BNP)水平]和术中指标[体温、平均动脉压、心率、呼吸、血氧分压(PO2)、酸碱值(pH)],采用多因素Logistic回归模型分析急性下肢缺血不良手术结局相关的影响因素,对相关因素进行受试者工作特征(ROC)曲线分析,计算预测效能并构建联合预测模型。结果单因素分析结果显示,不良组患者的APACHEⅡ评分、MB水平、CK水平、CK-MB水平、cTnT水平、LDH水平和BNP水平均高于良好组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,APACHEⅡ评分、MB水平、CK水平、CK-MB水平、cTnT水平、LDH水平和BNP水平较高均为急性下肢缺血不良手术结局的危险因素(P﹤0.05)。APACHEⅡ评分≥55.102分、MB≥33.290 ng/ml、cTnT≥0.205μg/L对于急性下肢缺血不良手术结局具有中等预测价值(P﹤0.05);CK≥141.220 U/L、CK-MB≥51.560 U/L、LDH≥247.355 U/L、BNP≥267.830 ng/L对于急性下肢缺血不良手术结局具有较低的预测价值(P﹤0.05);心肌酶谱指标MB、CK、CKMB、cTnT、LDH联合检测对于急性下肢缺血手术不良结局具有中等预测价值(P﹤0.05);全部危险因素构建的联合预测模型对于急性下肢缺血不良手术结局具�Objective To investigate the predictive value of myocardial enzyme spectrum combined with acute physiology and chronic health evaluation(APACHE)Ⅱscore for surgical outcomes of acute lower extremity ischemia.Method The clinical data of 173 patients with acute lower extremity ischemia who underwent surgical treatment in the First Hospital of Zhangjiakou from January 2018 to December 2022 were collected.Among them,124 patients with good surgical outcomes were included in the good group,and 49 patients with adverse outcomes were included in the bad group.The general indicators,etiology,preoperative indicators[ischemic time,activated partial thromboplastin(APTT),fibrinogen(FIB),D-dimer(D-D),Na level,K level,creatinine level,hematocrit,white blood cell count(WBC),APACHEⅡscore,myoglobin(MB)level,creatine kinase(CK)level,creatine kinase-MB(CK-MB)level,cardiac troponin T(cTnT)level,lactate dehydrogenase(LDH)level,B-type natriuretic peptide(BNP)level],and intraoperative indicators[body temperature,mean arterial pressure,heart rate,respiration,partial pressure of oxygen(PO2),pondus hydrogenii(pH)]of two groups of patients were compared,and multiple factor Logistic regression model was used to analyze the influencing factors related to adverse surgical outcomes in acute lower extremity ischemia.The relevant risk factors was analyzed by receiver operator characteristic(ROC)curve,predictive performance was calculated,and a joint risk model was constructed.Result The results of univariate analysis showed that the APACHE II score,MB level,CK level,CK-MB level,cTnT level,LDH level,and BNP level of patients in the bad group were higher than those in the good group,and the differences were statistically significant(P<0.05).The results of multivariate analysis showed that high APACHE II score,MB level,CK level,CK-MB level,cTnT level,LDH level,and BNP level were all risk factors for adverse surgical outcomes in acute lower extremity ischemia(P<0.05).APACHE II score≥55.102 points,MB≥33.290 ng/ml,cTnT≥0.205 ug/L had moderate

关 键 词：急性下肢缺血 心肌酶谱 急性生理学和慢性健康状况评价Ⅱ评分 手术结局 

分 类 号：R543[医药卫生—心血管疾病]