摘要
目的分析急性Stanford A型主动脉夹层患者术后需要接受肾脏替代治疗(RRT)的危险因素,根据危险因素构建预测模型并评估其预测效能,以期实现早期干预治疗。方法回顾分析2016年4月至2019年4月在南京市第一医院接受手术治疗的215例急性Stanford A型主动脉夹层患者信息,提取年龄、性别、基础血压、手术前血肌酐、术中血压变化、手术时间、体外循环时间、主动脉阻断时间、术中输血量(包括自体血)、晶体液输注量、胶体液输注量、术中尿量、出血量、总的液体平衡以及术后入ICU时血乳酸值等临床指标,分析这些指标与患者术后接受RRT的相关性。应用lasso回归进行临床指标筛选。应用筛选后指标通过logistic回归构建预测模型,计算预测模型的受试者工作特征曲线下面积(AUC)以及最佳阈值下的敏感度和特异度进行模型评估。结果全组38例术后需RRT,占17.67%。术前血肌酐值、手术时间、体外循环时间、主动脉阻断时间、术中血压低于80 mmHg(1 mmHg=0.133 kPa)时间、术中血压低于基础血压55%的时间、术中输血量、术中晶体液用量、术中尿量、术后入ICU时乳酸值是急性Stanford A型主动脉夹层患者术后需要接受肾脏替代治疗的独立危险因素,应用这些指标建立的预测模型的AUC为0.955(95%置信区间0.897~1.000),最佳阈值下特异度为96.1%,敏感度为90.9%。结论应用围手术期临床指标可以预测急性Stanford A型主动脉夹层患者手术后接受肾脏替代治疗可能性,为早期干预治疗提供可能。
Objective To analyze the risk factors for postoperative renal replacement therapy(RRT)in patients with acute Stanford type A aortic dissection.Develop and validate a prediction model based on the risk factors with the purpose of early intervention.Methods A retrospective analysis of 215 patients who underwent surgery for acute Stanford type A aortic dissection in our hospital from April 2016 to April 2019 were performed.Clinical variables including age,gender,basal blood pressure,preoperative serum creatinine,intraoperative blood pressure,operation time,cardiopulmonary bypass time,aortic occlusion time,intraoperative blood transfusion(including autologous blood),intraocular fluid infusion,colloidal fluid infusion,intraoperative urine volume,bleeding volume,total fluid balance,and postoperative blood lactate value were collected and their association with renal replacement therapy were analysed.Clinical variables were screened using lasso regression.Applying the post-filtering variables to construct a predictive model,calculating the area under the receiver operating characteristic curve(AUC)of the predictive model and the sensitivity and specificity under the optimal threshold for model evaluation.Results In the 215 patients with acute Stanford type A aortic dissection,38 patients required renal replacement therapy,accounting for 17.67%.Preoperative serum creatinine,operation time,cardiopulmonary bypass time,aortic occlusion time,intraoperative blood pressure less than 80mmHg time,intraoperative blood pressure less than 55%of basal blood pressure time,intraoperative blood transfusion,intraoperative crystal fluid dosage,intraoperative urine volume and lactate value after ICU admission were important risk factors for postoperative renal replacement therapy(RRT)in patients with acute Stanford type A aortic dissection.The AUC for the predictive model established using these variables was 0.955(95%CI:0.897-1.000).The specificity under the optimal threshold was 96.1%and the sensitivity was 90.9%.Conclusion Perioperative clinical variables can predict the possibility of RRT in patients with acute Stanford type A aortic dissection after surgery,which may provide the possibility for early intervention.
作者
洪亮
沈骁
章淬
黄福华
Hong Liang;Shen Xiao;Zhang Cui;Huang Fuhua(Department of Intensive Care Unit,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Cardiothoracic Surgery,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2020年第10期621-626,共6页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
江苏省临床医学科技专项(BE2017610)。
