摘要
目的 探讨影响心脏破裂伤术后住ICU时间的因素，为预防术后住ICU时间延长提供依据。方法 对2009年1月至2017年1月无锡市人民医院收治的25例心脏破裂伤患者进行回顾性分析。统计22例住ICU生存患者年龄、致伤原因、合并症、输血情况、机械通气时间、血管活性药物应用时间、住ICU时间等信息和入科时血红蛋白（hemoglobin，Hb）、红细胞压积（hematocrit，Hct）、血肌酐、血乳酸和肌酸激酶同工酶（creatine kinase muscle b, CK-MB）检验数值，并根据术后住ICU时间是否大于3 d，将患者分为A（〉3 d）、B（≤ 3 d）两组，采用SPSS 20.0软件、MedCalc软件进行统计学分析，利用Pearson相关性分析和ROC曲线评价相关指标的预测意义。结果 本研究纳入22例住ICU生存患者，其中A组11例，B组11例。将A、B两组的临床信息进行统计学分析后发现A组较B组Hb （P=0.001）、Hct （P=0.008）更低，CK-MB（P=0.005）、血乳酸（P〈0.01）更高，输血量（P=0.002）更大，合并症2 项以上的患者更多（P=0.024），机械通气时间（P=0.001）和血管活性药物应用时间（P=0.003）更长。进一步的Pearson相关性分析显示患者Hb和Hct与血管活性药物应用时间、住ICU时间、机械通气时间呈负相关（均P〈0.05）；血乳酸、CK-MB与血管活性药物应用时间、住ICU时间、机械通气时间呈正相关（均P〈0.05）。ROC曲线表明血乳酸、Hct和CK-MB三种检测指标对判断心脏破裂伤术后患者住ICU时间延长均有预测意义，三者之间曲线下面积（area under the curve, AUC）比较差异无统计学意义（均P〉0.05），并通过ROC 曲线得到血乳酸（≥ 3.4 mmol/L）、Hct（≤ 39%）和CK-MB（≥ 58 U/L）三个指标临床诊断的最佳临界值。结论 Hb、Hct、CK-MB、血乳酸、输血量、合并症、机械通气时间和血管活性药物应用时间均为影响心脏破裂伤术后患者住ICU时间的因素，其中血乳酸、Hct、CK-MB 指标检测对预测患者住ICU时间延长有显著意义。
Objective To investigate the influence factors on length of ICU stay in cardiac rupture patients after surgical repair. Methods A retrospective study was conducted and enrolled survived cardiac rupture patients admitted to ICU of Wuxi People＇s Hospital from January 2009 to January 2017. Clinical data of patients were recorded including age, causes, complications, blood transfusion, duration of mechanical ventilation, duration of vasoactive agent employment, and length of ICU stay. At the same time, the laboratory findings were documented including hemoglobin（Hb）, hematocrit （Hct）,serum creatinine, blood lactic acid and creatine kinase muscle b（CK-MB）. Patients were divided into two groups according to length of ICU stay（A group 〉3 d, B group ~〈 3 d）. Data were analyzed using SPSS20.0 and MedCalc software. Pearson correlation test and ROC curve were taken to analyze the predicting factors for the prognosis. Results Twenty-two patients were referred to ICU after operation and survived. The length of ICU stay varied from 2 to 12 d. The statistical analysis showed the levels of Hb and Hct in group A were lower than those in group B （P〈0.05）; the levels of CK-MB and lactic acid in group A were higher than those in group B （P〈0.05）; and larger volume of blood transfusion （P=0.002）, higher complications （P=0.024）, longer duration of mechanical ventilation （P=0.001） and longer duration of vasopressor application （P=0.003） were found in group A. Pearson correlation test showed Hb and Hct had negative correlation with duration of mechanical ventilation, duration of vasoactive agent application and length of ICU stay （P〈0.05）, whereas the CK-MB and lactic acid had positive correlation with duration of mechanical ventilation, duration of vasoactive agent employment and length of ICU stay （P〈0.05）. ROC curve showed lactic acid, Hct, and CK-MB all had significance in prediction of prolonged ICU stay, and there were no statistically significant differences in areas under the curve（AUC） among these three biomarkers （P〉0.05）. With the employment of ROC curve, the optimal cut-off points of three biomarkers for clinical diagnosis were lactic acid ≥3.4 mmol/L, Hct≤39%, CK-MB ≥58 U/L. Conclusion Hb, Hct, lactic acid, CK-MB, blood transfusion, complications, duration of mechanical ventilation, duration of vasoactive agent employment were factors influencing on length of ICU stay in cardiac rupture patients after operations. The levels of lactic acid, Hct, and CK-MB had significance in prediction of prolonged ICU stay.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第3期318-322,共5页
Chinese Journal of Emergency Medicine
