经胸腔镜心脏瓣膜手术术后低氧血症风险预测模型的建立
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i2.18881
Abstract
目的：探讨经胸腔镜心脏瓣膜术后中重度低氧血症的危险因素及预防策略，并构建风险预测模型。方法：回顾性分析2023年1月至2023年12月在我院经胸腔镜行心脏瓣膜手术治疗的患者，借助单因素及多因素Logistic回归分析方法筛选中重度低氧血症患者的相关危险因素并构建风险预测模型。结果：本次研究共216例行经胸腔镜心脏瓣膜手术患者，其中术后中重度低氧血症患者共65（30.09%）例。两组间性别、体质指数（BMI）、手术时长、谷草转氨酶（AST）、谷丙转氨酶（ALT）、肌酸激酶同工酶（CK-MB）的基线信息差异有统计学意义（P<0.05）。单因素分析显示BMI（OR=1.18，95%CI 1.03 ~ 1.36），体外循环时间（OR=1.01，95%CI 1.01 ~ 1.01），手术时间（OR=1.01，95%CI 1.01 ~ 1.01），ALT（OR=1.02，95%CI 1.01 ~ 1.04），降钙素原（PCT）（OR=1.02，95%CI 1.01 ~ 1.04）与经胸腔镜心脏瓣膜手术术后低氧血症有关。多因素logistic回归分析显示，BMI、PCT及手术时间为经胸腔镜瓣膜术后患者中重度低氧血症独立危险因素。基于上述因素建立的列线图模型，该模型预测术后中重度低氧患者的AUC值为0.71（95% CI：0.62-0.80）。结论：BMI增加以及手术时间延长均为经胸腔镜瓣膜术后患者中重度低氧血症的独立危险因素，基于上述因素构建的预测模型能定量、简便地评估经胸腔镜心脏瓣膜术后出现中重度低氧血症的风险。
Keywords
心脏术后；低氧血症；风险因素；预测模型
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[1] BECKMANN A, MEYER R, LEWANDOWSKI J, et al. German Heart Surgery Report 2022: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery[J]. Thorac Cardiovasc Surg, 2023,71(5):340-355.
[2] HUA K, ZHAO Y, DONG R, et al. Minimally Invasive Cardiac Surgery in China: Multi-Center Experience[J]. Med Sci Monit, 2018,24:421-426.
[3] HA B, USMAN A A, AUGOUSTIDES J G. Minimally Invasive Cardiac Surgery-Identifying Opportunities for Further Improvement in the Quality of Postoperative Patient Recovery[J]. J Cardiothorac Vasc Anesth, 2020,34(12):3231-3233.
[4] KEYL C, SIEPE M. Unilateral lung injury after minimally invasive cardiac surgery: more questions than answers[J]. Eur J Cardiothorac Surg, 2016,49(2):505-506.
[5] ZUBAIR M H, SMITH J M. Updates in Minimally Invasive Cardiac Surgery for General Surgeons[J]. Surg Clin North Am, 2017,97(4):889-898.
[6] IRISAWA Y, HIRAOKA A, TOTSUGAWA T, et al. Re-expansion pulmonary oedema after minimally invasive cardiac surgery with right mini-thoracotomy[J]. Eur J Cardiothorac Surg, 2016,49(2):500-505.
[7] TAMURA T, ITO T, YOKOTA S, et al. Incidence of reexpansion pulmonary edema in minimally invasive cardiac surgery[J]. Nagoya J Med Sci, 2019,81(4):647-654.
[8] Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012. 307(23): 2526-33.
[9] Song XC, Nie S, Xiao JL, et al. Risk factors and long-term prognosis for postoperative hypoxemia in patients with acute type A aortic dissection: A retrospective observational study. Medicine (Baltimore). 2022. 101(50): e32337.
[10] Wang D, Ding X, Su Y, et al. Incidence, Risk Factors, and Outcomes of Severe Hypoxemia After Cardiac Surgery. Front Cardiovasc Med. 2022. 9: 934533.
[11] Luo X, Ying Y, Yin L, Chang P. Analysis of risk factors for hypoxemia in PACU for patients undergoing thoracoscopic lung cancer resection based on logistic regression model. BMC Anesthesiol. 2025. 25(1): 174.
[12] Wang X, Ma J, Lin D, et al. The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection. Medicine (Baltimore). 2023. 102(33): e34704.
[13] YU W, LIANG Y, GAO J, et al. Study on risk factors and treatment strategies of hypoxemia after acute type a aortic dissection surgery[J]. J Cardiothorac Surg, 2024,19(1):273.
[14] SHENG W, LE S, SONG Y, et al. Preoperative Nomogram and Risk Calculator for Postoperative Hypoxemia and Related Clinical Outcomes Following Stanford Type A Acute Aortic Dissection Surgery[J]. Front Cardiovasc Med, 2022,9:851447.
[15] 张瑛杰, 韩劲松, 孙彪, 等. 肥胖患者行非体外循环冠状动脉旁路移植术后低氧血症危险因素分析[J]. 中国心血管病研究,2022,20(10):908-913.
[16] MIRABELLI M, MISITI R, SICILIA L, et al. Hypoxia in Human Obesity: New Insights from Inflammation towards Insulin Resistance-A Narrative Review[J]. Int J Mol Sci, 2024,25(18)
[17] 江雪艳, 丁士骜, 姜兆磊,等. 微创冠状动脉旁路移植术后早期严重低氧血症的高危因素研究[J]. 中国心血管病研究,2022,20(10):904-907.
[18] DING X, CHENG D, SUN B, et al. Nomogram and risk calculator for severe hypoxemia after heart valve surgery[J]. Front Cardiovasc Med, 2022,9:972449.
[19] 张良燕, 唐帅, 张秀华,等. 麻醉后恢复室患者低氧血症发生率及高危因素的回顾性分析[J]. 基础医学与临床,2020,40(09):1242-1246.
[20] SCHUETZ P, BEISHUIZEN A, BROYLES M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use[J]. Clin Chem Lab Med, 2019,57(9):1308-1318.
[21] 李小芳, 曹永科, 程国栋,等. 降钙素原对心脏直视手术预后的评估价值[J]. 中国临床研究,2016,29(04):469-471+475.
[22] DENG H, WU X, PENG B. Early Predictive Value of Infectious Markers for Ventilator-associated Pneumonia after Stanford Type A Aortic Dissection Surgery[J]. Rev Cardiovasc Med, 2025,26(2):26002.
[2] HUA K, ZHAO Y, DONG R, et al. Minimally Invasive Cardiac Surgery in China: Multi-Center Experience[J]. Med Sci Monit, 2018,24:421-426.
[3] HA B, USMAN A A, AUGOUSTIDES J G. Minimally Invasive Cardiac Surgery-Identifying Opportunities for Further Improvement in the Quality of Postoperative Patient Recovery[J]. J Cardiothorac Vasc Anesth, 2020,34(12):3231-3233.
[4] KEYL C, SIEPE M. Unilateral lung injury after minimally invasive cardiac surgery: more questions than answers[J]. Eur J Cardiothorac Surg, 2016,49(2):505-506.
[5] ZUBAIR M H, SMITH J M. Updates in Minimally Invasive Cardiac Surgery for General Surgeons[J]. Surg Clin North Am, 2017,97(4):889-898.
[6] IRISAWA Y, HIRAOKA A, TOTSUGAWA T, et al. Re-expansion pulmonary oedema after minimally invasive cardiac surgery with right mini-thoracotomy[J]. Eur J Cardiothorac Surg, 2016,49(2):500-505.
[7] TAMURA T, ITO T, YOKOTA S, et al. Incidence of reexpansion pulmonary edema in minimally invasive cardiac surgery[J]. Nagoya J Med Sci, 2019,81(4):647-654.
[8] Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012. 307(23): 2526-33.
[9] Song XC, Nie S, Xiao JL, et al. Risk factors and long-term prognosis for postoperative hypoxemia in patients with acute type A aortic dissection: A retrospective observational study. Medicine (Baltimore). 2022. 101(50): e32337.
[10] Wang D, Ding X, Su Y, et al. Incidence, Risk Factors, and Outcomes of Severe Hypoxemia After Cardiac Surgery. Front Cardiovasc Med. 2022. 9: 934533.
[11] Luo X, Ying Y, Yin L, Chang P. Analysis of risk factors for hypoxemia in PACU for patients undergoing thoracoscopic lung cancer resection based on logistic regression model. BMC Anesthesiol. 2025. 25(1): 174.
[12] Wang X, Ma J, Lin D, et al. The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection. Medicine (Baltimore). 2023. 102(33): e34704.
[13] YU W, LIANG Y, GAO J, et al. Study on risk factors and treatment strategies of hypoxemia after acute type a aortic dissection surgery[J]. J Cardiothorac Surg, 2024,19(1):273.
[14] SHENG W, LE S, SONG Y, et al. Preoperative Nomogram and Risk Calculator for Postoperative Hypoxemia and Related Clinical Outcomes Following Stanford Type A Acute Aortic Dissection Surgery[J]. Front Cardiovasc Med, 2022,9:851447.
[15] 张瑛杰, 韩劲松, 孙彪, 等. 肥胖患者行非体外循环冠状动脉旁路移植术后低氧血症危险因素分析[J]. 中国心血管病研究,2022,20(10):908-913.
[16] MIRABELLI M, MISITI R, SICILIA L, et al. Hypoxia in Human Obesity: New Insights from Inflammation towards Insulin Resistance-A Narrative Review[J]. Int J Mol Sci, 2024,25(18)
[17] 江雪艳, 丁士骜, 姜兆磊,等. 微创冠状动脉旁路移植术后早期严重低氧血症的高危因素研究[J]. 中国心血管病研究,2022,20(10):904-907.
[18] DING X, CHENG D, SUN B, et al. Nomogram and risk calculator for severe hypoxemia after heart valve surgery[J]. Front Cardiovasc Med, 2022,9:972449.
[19] 张良燕, 唐帅, 张秀华,等. 麻醉后恢复室患者低氧血症发生率及高危因素的回顾性分析[J]. 基础医学与临床,2020,40(09):1242-1246.
[20] SCHUETZ P, BEISHUIZEN A, BROYLES M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use[J]. Clin Chem Lab Med, 2019,57(9):1308-1318.
[21] 李小芳, 曹永科, 程国栋,等. 降钙素原对心脏直视手术预后的评估价值[J]. 中国临床研究,2016,29(04):469-471+475.
[22] DENG H, WU X, PENG B. Early Predictive Value of Infectious Markers for Ventilator-associated Pneumonia after Stanford Type A Aortic Dissection Surgery[J]. Rev Cardiovasc Med, 2025,26(2):26002.
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