摘要
目的探讨冠状动脉旁路移植术(CABG)后发生低心排血量综合征(LCOS)的危险因素并构建预测LCOS发生风险的列线图模型。方法选择2019年10月至2022年5月于河南省人民医院心脏中心行CABG手术的231例冠状动脉粥样硬化性心脏病(CAHD)患者为研究对象,将患者按照7:3的比例随机分为训练集(n=162)和验证集(n=69)。比较训练集与验证集患者的各项参数,以明确训练集与验证集患者的可比性。根据CABG术后是否发生LCOS,将训练集患者分为LCOS组(n=33例)和非LCOS组(n=129例),并对训练集中的样本参数进行单因素和多因素logistic回归分析,得出CABG术后发生LCOS的独立危险因素,构建CABG术后LCOS发生风险的列线图预测模型,使用受试者操作特征曲线、校准曲线和决策曲线分析评估模型的区分度、校准度和临床适用性。结果训练集和验证集患者的LCOS发生率分别为20.37%(33/162)和18.84%(13/69)。训练集和验证集患者的各项参数比较差异均无统计学意义(P>0.05)。训练集中非LCOS组与LCOS组患者的年龄、心率、血尿素氮、血清肌酐、估测肾小球滤过率(eGFR)、血清N端B型钠尿肽前体(NT-proBNP)、血清肌钙蛋白T、左心室射血分数(LVEF)、二尖瓣反流面积、合并心肌梗死史、纽约心脏病学会分级Ⅲ~Ⅳ级占比、体外循环手术占比、手术时间、术中出血量以及术后血流动力学指标中心静脉压、肺动脉舒张压、肺动脉搏动指数(PAPI)比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示,术前LVEF降低[比值比(OR)=0.891,95%置信区间(CI):0.832~0.954,P=0.001]、术前eGFR降低(OR=0.963,95%CI:0.934~0.994,P=0.018)、术前NT-proBNP升高(OR=1.001,95%CI:1.000~1.001,P=0.006)、手术时间增加(OR=1.013,95%CI:1.003~1.022,P=0.008)及术后PAPI降低(OR=0.094,95%CI:0.028~0.319,P=0.000)是CABG术后发生LCOS的独立危险因素。基于上述指标构建列线图模型。列线图模型在训练集中预测LC
Objective To investigate the influencing factors of low cardiac output syndrome(LCOS)after coronary artery bypass grafting(CABG)and construct a nomogram model to predict the risk of LCOS occurrence.Methods A total of 231 patients with coronary atherosclerotic heart disease who underwent CABG surgery in the Heart Center of Henan Provincial People′s Hospital from October 2019 to May 2022 were selected for the study.The patients were randomly divided into a training set(n=162)and a validation set(n=69)at a ratio of 7:3.The comparability between the parameters of the patients in the training and validation sets was assessed.Based on the occurrence of LCOS after CABG,patients in the training set were divided into LCOS group(n=33)and non-LCOS group(n=129).Univariate and multivariate logistic regression analysis were conducted on the sample parameters in the training set to identify independent risk factors for LCOS after CABG.A nomogram prediction model for the risk of LCOS after CABG was constructed,and its discrimination,calibration,and clinical applicability were evaluated by using the receiver operating characteristic curve,calibration curve,and decision curve analysis.Results The incidence of LCOS in patients of the training and validation sets was 20.37%(33/162)and 18.84%(13/69),respectively.There were no statistically significant differences in various parameters between the training and validation sets(P>0.05).In the training set,there were statistically significant differences in the following parameters between the non-LCOS group and the LCOS group patients,including age,heart rate,blood urea nitrogen,serum creatinine,estimated glomerular filtration rate(eGFR),serum N-terminal pro B-type natriuretic peptide(NT-proBNP),serum troponin T,left ventricular ejection fraction(LVEF),mitral regurgitation area,history of myocardial infarction,proportion of NYHA classⅢ-Ⅳ,proportion of patients requiring cardiopulmonary bypass,surgical duration,intraoperative bleeding volume,and postoperative hemodynamic indicators
作者
曹烨
王书鹏
王磊
孟树萍
CAO Ye;WANG Shupeng;WANG Lei;MENG Shuping(Adult Cardiac Surgical Care Unit,Heart Center of Henan Provincial People′s Hospital/Fuwai Central China Cardiovascular Hospital/Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2024年第5期423-430,437,共9页
Journal of Xinxiang Medical University
基金
河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20220113)。
关键词
冠状动脉旁路移植术
低心排血量综合征
列线图模型
coronary artery bypass grafting
low cardiac output syndrome
nomogram prediction model
