摘要
目的回顾性分析危重孕产妇发生急性心肌损伤的临床特点并分析其危险因素。方法本研究为单中心回顾性队列研究,纳入北京大学人民医院2009年1月1日至2019年12月31日接受机械通气治疗的重症产妇共143例。收集患者临床资料、妇产科相关指标、结局指标、预后相关指标,根据心肌损伤的诊断标准,将患者分为心肌损伤组和非心肌损伤组。依次采用单因素比较和多因素logistic回归分析急性心肌损伤的独立危险因素,并通过受试者工作特征曲线评价独立危险因素对心肌损伤的预测价值。结果共有61例(42.7%)患者出现急性心肌损伤,与非心肌损伤组相比,心肌损伤组患者的谷草转氨酶、肌酐、白蛋白、血红蛋白、乳酸、体温、发生低血压、手术时间、术中出血量的比率显著升高(P<0.05)。将上述指标纳入多因素logistic回归分析后发现,早期肌酐水平(OR=1.016,95%CI:1.004~1.027,P=0.008)、乳酸水平(OR=1.492,95%CI:1.053~2.115,P=0.025)和术中出血量(OR=1.0002,95%CI:1.0001~1.0004,P=0.011)是心肌损伤的独立危险因素;受试者工作特征曲线分析显示其曲线下面积为0.853,标准误为0.033,95%可信区间为0.789~0.917,提示有较好的预测价值。结论早期肌酐水平、乳酸水平和术中出血量是危重孕产妇发生心肌损伤的独立危险因素,且对于预防心肌损伤的发生具有临床意义。
Objective To retrospectively analyze the clinical characteristics and risk factors of critically ill obstetric patients with acute myocardial injury.Methods We conducted a single center,retrospective,cohort study.It enrolled 143 critically ill obstetric patients who received mechanical ventilation,from Jan 1st 2009 to Dec31th 2019,in Peking University People′s Hospital.Patients′clinical variables,obstetric variables,outcomes and prognostic variables were collected.According to the diagnostic criteria of myocardial injury,the patients were assigned to myocardial injury group and non-myocardial injury group.Independent risk factors of acute myocardial injury were analyzed by univariate analysis and multivariate logistic regression respectively,and the predicting value of independent risk factors for myocardial injury was estimated by the receiver operating characteristic curve.Results Acute myocardial injury was found in 61 patients(42.7%).In myocardial injury group,patients′aspartate aminotransferase(AST),creatinine,albumin,hemoglobulin,lactate,temperature,the incidence of hypotension,time of surgery and the volume of blood loss during operation were increased significantly,when compared with that in non-myocardial injury group(P<0.05).After including former variables into multivariate logistic regression,we discovered that early creatinine level(OR=1.016,95%CI:1.004~1.027,P=0.008),lactate level(OR=1.492,95%CI:1.053~2.115,P=0.025)and the volume of blood loss during operation(OR=1.0002,95%CI:1.0001~1.0004,P=0.011)were independent risk factors of myocardial injury.The area under ROC curve(0.853),standard error(0.033)and 95%confidence intervals(0.789~0.917)of the receiver operating characteristic curve,indicating a good predicting value.Conclusion Early creatinine level,lactate level and the volume of blood loss during operation are independent risk factors of myocardial injury in critically ill obstetric patients,and play a crucial role in predicting the development of myocardial injury.
作者
刘晓江
赵慧颖
王光杰
张晓红
刘国莉
安友仲
LIU Xiaojiang;ZHAO Huiying;WANG Guangjie;ZHANG Xiaohong;LIU Guoli;AN Youzhong(Department of Critical Care Medi-cine,Peking University People′s Hospital,Beijing 100044,China)
出处
《实用医学杂志》
CAS
北大核心
2022年第13期1657-1661,共5页
The Journal of Practical Medicine
基金
国家临床重点专科建设项目(编号:2011-872)
北京大学人民医院研究与发展基金资助课题(编号:RDY2019-43)。
关键词
危重孕产妇
急性心肌损伤
围产期出血
critically ill obstetric patients
acute myocardial injury
perinatal hemorrhage
