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心血管外科术后非计划性二次开胸探查术后患者住院死亡的预后因素分析

The prognosis factors of hospital mortality for unplanned re-explorations after cardiovascular surgery

摘要:

目的:探讨心血管外科术后行非计划性二次开胸探查术后患者住院死亡的预后因素。方法:回顾性分析2015年3月至2019年3月于首都医科大学附属北京安贞医院行心血管手术,术后滞留于ICU并行非计划性二次开胸探查手术的311例患者的资料。男性241例,女性70例,年龄(58.3±12.5)岁(范围:20~85岁)。采用Logistics回归进行多因素分析确定患者住院死亡的预后因素。构建患者住院死亡的评估模型,计算该模型的受试者工作特征曲线下面积,采用拟合优度检验进一步评价该模型的评估效能。结果:311例患者中,81例患者死亡。Logistics回归分析结果显示,二次开胸探查手术时间、探查前48 h内最差血肌酐值、探查后24 h内最差乳酸值,以及二次开胸前后发生心功能不全、呼吸功能不全、急性肾损伤是心血管外科术后二次开胸患者住院死亡的独立预后因素( P值均<0.05)。由这些预后因素构成的评估模型的曲线下面积为0.910,评估效能良好(χ 2=4.243, P=0.835)。 结论:二次开胸探查手术时间、探查前48 h内最差血肌酐值、探查后24 h内最差乳酸值,二次开胸前后发生心功能不全、呼吸功能不全、急性肾损伤是心血管外科术后二次开胸患者住院死亡的预后因素。明确二次开胸患者住院死亡的预后因素,能够有效指导临床医师对术后危重患者进行筛查,及时调整临床治疗策略,改善患者预后。

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abstracts:

Objective:To examine the prognosis factors of hospital mortality for unplanned re-explorations after cardiovascular surgery.Methods:Totally 311 consecutive patients undergoing unplanned re-explorations after cardiovascular surgery in the Center for Cardiac Intersive Care of Beijing Anzhen Hospital, Capital Medical University between March 2015 and March 2019 were analyzed retrospectively. There were 241 males and 70 females, aging (58.3±12.5) years (range: 20 to 85 years). Demographic characteristics, operation information, perioperative complications were collected to set up a database. The patients were divided into survival group and non-survival group according to in-hospital mortality. Logistic regression was used for multivariable analysis to explore the prognosis factors of hospital mortality. These statistically significant indicators were selected for plotting the receiver operation characteristic curves, calculating the area under the curve(AUC). The Hosmer-Lemeshow C-statistic was used to evaluate the efficiency of the new model.Results:Hospital mortality was 26.0% (81/311). Multivariate analysis revealed that the worst serum creatinine within 48 hours before re-operation, the worst lactate during the first 24 hours after re-operation,re-operation time, cardiac dysfunction,acute kidney injury, and respiratory dysfunction were independent prognosis factors(all P<0.05). The AUC of the new assessment model constituted by these prognosis factors was 0.910, and the Hosmer-Lemeshow C-statistic was 4.243 ( P=0.835). Conclusions:The worst serum creatinine within 48 hours before re-operation, the worst lactate during the first 24 hours after re-operation,re-operation time, cardiac dysfunction, acute kidney injury, and respiratory dysfunction were the independent prognosis factors of hospital mortality for unplanned re-explorations after cardiovascular surgery. To identify these factors can promote preventive measures effectively and improve the prognosis of patients.

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