摘要
目的分析体外循环术（cardiopulmonarybypass，CPB）后并发血管麻痹综合征（vasoplegicsyn-drome-VS）的相关危险因素。方法连续纳入CPB下行心脏手术后发生VS患者和未发生VS患者各32例和64例，分别记为VS组和非VS组。收集所有患者相关资料，通过组间单因素比较及多因素Logistic回归分析等方法获得CPB后并发VS的危险因素，采用受试者工作特征曲线（receiver operating characteristic curve-ROC）检验危险因素对CPB后并发VS的预测价值。结果两组组间基线资料比较发现左室射血分数（left ventricular ejection fraction，LVEF）、术前ACEI类药物使用人数、心功能分级、术前利尿剂使用人数、CPB后2h血浆血管加压素水平、心脏直视手术人数及手术持续时间差异有统计学意义，此7项指标经多因素Logistic回归分析结果显示LVEF（OR=0．82，95％CI：0．77—0．89，P〈0．01）、CPB后2h血浆血管加压素水平（OR=0．84，95％CI：0．77-0．91，P〈0．01）、心功能分级（OR=1．21，95％CI：1．07-1．38，P〈0．01）以及术前使用ACEI类药物（OR=1．18，95％CI：1．12—1．25，P〈0．01）等4个因素与CPB后并发VS有显著相关性。通过ROC曲线检验上述4个危险因素联合预测CPB后并发VS的预测效能．计算ROC曲线下面积为0．778（P〈0．01，95％CI：0．725～0．821）。结论LVEF减少、CPB后2h血浆血管加压素水平降低、心功能分级较高及术前使用ACEI类药物是CPB后并发VS的独立危险因素，联合这4个危险因素可对CPB后并发VS进行预测。
Objective with cardiopulmonary bypass To explore the risk factors of vasoplegic syndrome （VS） in patients （CPB） . Methods Thirty-two patients who underwent CPB and then developed VS （VS group） and sixty-four patients without VS （non-VS group） were consecutively enrolled in the study. The clinical data of all the patients were retrospectively analyzed. The independentt-test, X2-test and multivariate Logistic regression analysis were used to evaluate the risk factors of VS in patients with CPB. The power of the risk factors to predict the VS secondary to CPB was examined by receiver operating characteristic （ROC） curves. Results Comparison of baseline data showed that there were significant differences in the left ventricular ejection fraction （LVEF）, the number of patients who preoperatively used ACEI, the New York Heart Association （NYHA） functional classification, the number of patients who preoperatively used diuretic, the plasma levels of arginine vasopressin 2 h after CBP, the number of patients who underwent the open heart surgery and the duration of operation between the two groups （ allP 〈 0. 05 ） . The multivariable logistic analysis showed that LVEF （OR =0. 82, 95 % CI： 0. 77-0. 89, P 〈0. 01）, the plasma levels of arginine vasopressin 2 h after CBP （OR =0.84, 95% CI： 0.77-0.91, P 〈0.01）, the NYHA classification （OR = 1.21, 95 % CI： 1.07-1.38, P 〈0.01） and preoperative use of ACEI （OR =1.18, 95% CI： 1.12-1.25, P 〈 0. 01） were markedly correlated with the VS secondary to CPB. The ROC curves showed that the area under the curve was 0. 778 （ P 〈 0. 01, 95 % CI ： 0. 725-0. 821 ） . Conclusion The decreased LVEF and plasma levels of arginine vasopressin 2 h after CBP, the higher NYHA grade and preoperative use of ACEI are independent risk factors of VS in patients with CPB. The four risk factors combined are valuable for the prediction of VS in patients with CPB.
出处
《医学分子生物学杂志》
CAS
2014年第3期179-182,共4页
Journal of Medical Molecular Biology
关键词
体外循环术
血管麻痹综合征
危险因素
ROC曲线
cardiopulmonary bypass
vasoplegic syndrome
risk factor
receiver operatingcharacteristic curve
