中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

术前血尿酸水平对心脏机械瓣膜置换术后发生机械通气时间延长的预测价值

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目的 探讨心脏机械瓣膜置换患者术前血清尿酸(UA)水平与术后机械通气时间延长(PMV)之间的关系及其预测价值。 方法 回顾性分析 2017 年 1 月至 2017 年 12 月间在安徽医科大学第一附属医院心脏大血管外科行心脏机械瓣膜置换手术?例患者的临床资料,其中男 164 例,平均年龄(55.6±11.4)岁;女 147 例,平均年龄(54.2±9.8)岁。根据患者术后机械通气时间是否>48 h,分为 PMV 组(>48 h)和对照组。采用 Spearman 等级相关系数和 logistic 回归分析研究术前血清 UA 水平与术后 PMV 之间的关系。UA 对 PMV 的预测效能评价使用受试者工作特征(ROC)曲线完成。 结果 311 例患者入选,38 例(12.2%)发生术后 PMV。全部患者术前血清 UA 平均浓度为(6.11±1.94)mg/dl,PMV 组 UA 平均浓度显著高于对照组[(7.48±2.24)mg/dl vs.(5.92±1.82)mg/dl,P<0.001]。秩相关分析显示血清中 UA 的浓度与术后 PMV 的发生呈正相关(rs=0.205,P<0.001)。多因素 logistic 回归分析显示术前血清 UA 水平升高与心脏机械瓣置换术后 PMV 的发生独立相关 [优势比(OR)=1.42,95% 可信区间 (CI)1.13~1.78,P=0.003]。ROC 曲线分析显术前 UA 对预测术后 PMV 的曲线下面积为 0.721,95%CI 0.635~0.806,6.40 mg/dl 为最佳截断值,此时敏感性为 76.3%,特异性为 63%。 结论 术前血清 UA 水平升高是心脏机械瓣膜置换术后 PMV 的发生独立危险因素且具有较好的预测价值。

Objective To investigate the association of preoperative serum uric acid (UA) levels with postoperative prolonged mechanical ventilation (PMV) in patients undergoing mechanical heart valve replacement. Methods Clinical data of 311 patients undergoing mechanical heart valve replacement in The First Affiliated Hospital of Anhui Medical University from January 2017 to December 2017 were retrospectively analyzed. There 164 males at age of 55.6±11.4 years and 147 females at age of 54.2±9.8 years. The patients were divided into PMV group (>48 h) and control group according to whether the duration of postoperative mechanical ventilation was greater than 48 hours. Spearman's rank correlation coefficient and logistic regression analysis were conducted to evaluate the relationship between preoperative UA and postoperative PMV. The predictive value of UA for PMV was undertaken using the receiver operating characteristic (ROC) curve. All reported P values were 2-sided, and P values less than 0.05 was statistical significance. Results A total of 311 patients were enrolled, 38 (12.2%) developed postoperative PMV. Preoperative serum UA level mean values were 6.11±1.94 mg/dl, while the mean UA concentration in the PMV group was significantly higher than that in the control group (7.48±2.24 vs. 5.92±1.82 mg/dl, P<0.001). Rank correlation analysis showed that UA was positively correlated with postoperative PMV (rs=0.205, P<0.001). Multivariate logistic regression analysis demonstrated that preoperative elevated UA was associated independently with postoperative PMV with odds ratio (OR)=1.42 and confidence interval (CI) 1.13–1.78 (P=0.003). The area under the ROC curve of UA predicting PMV was 0.72, 95% CI: 0.635–0.806, 6.40 mg/dl was the optimal cut-off value, and the sensitivity and specificity was 76.3% and 63% at this time, respectively. Conclusions Preoperative elevated serum UA is an independent risk factor for postoperative PMV in patients undergoing mechanical heart valve replacement and has a good predictive value.

关键词: 尿酸; 机械通气; 瓣膜置换; Logistic 回归; ROC 曲线

Key words: Uric acid; mechanical ventilation; valve replacement; logistic regression; receiver operating characteristic curve

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