摘要
Abstract
Objective To investigate the risk factors for mortality in patients with perioperative stress cardiomyopathy undergoing cardiac surgery.Methods Clinical data of 146 patients with perioperative stress cardiomyopathy undergoing cardiac surgery were retrospectively collected,including 102 patients in a survival group and 44 patients in a death group.General data,surgical types,blood indicators,complications,and cardiac function parameters were compared between the two groups.Logistic regression analysis was used to explore the risk factors for mortality in these patients.Results Among the enrolled 146 patients with stress cardiomyopathy,the overall mortality rate was 30.14%.Statistically significant differences were observed between the survival and death groups in cardiac function classification,preoperative anxiety,preoperative use of vasoactive drugs,postoperative malignant arrhythmia,postoperative thrombosis formation and embolism,postoperative re-sternotomy,postoperative re-intubation,postoperative left ventricular end-diastolic diameter(LVEDD),postoperative left ventricular ejection fraction(LVEF),postoperative C-reactive protein(CRP),postoperative creatinine,postoperative cardiac troponin I(cTnI),postoperative creatine kinase-MB(CK-MB),postoperative N-terminal pro-B-type natriuretic peptide(NT-proBNP),and duration of mechanical ventilation(all P<0.05).Binary Logistic regression analysis incorporating the above factors revealed that postoperative creatinine[OR(95%CI):1.060(1.006-1.117),P=0.028],postoperative NT-proBNP[OR(95%CI):1.003(1.001-1.005),P=0.007],and duration of mechanical ventilation[OR(95%CI):1.882(1.140-3.107),P=0.014]were independent risk factors for mortality in critically ill patients with perioperative stress cardiomyopathy undergoing cardiac surgery.ROC curve analysis showed that the area under the curve(AUC)for the combined prediction of creatinine,duration of mechanical ventilation,and NT-proBNP was 0.866(95%CI 0.792-0.940),which was superior to any single indicator.The sensitivity of the combined detection was 0.864,and specificity was 0.269.DeLong test indicated that the AUC of the combined prediction was significantly higher than that of creatinine(Z=2.841,P=0.005),NT-proBNP(Z=3.670,P<0.001),and duration of mechanical ventilation(Z=4.920,P<0.001).Conclusion Postoperative creatinine,NT-proBNP,and duration of mechanical ventilation are independent risk factors for mortality in patients with perioperative stress cardiomyopathy undergoing cardiac surgery.The combined detection of these three indicators has high predictive value for mortality risk.关键词
心外科手术/围手术期/应激性心肌病/死亡/危险因素Key words
cardiac surgery/perioperative period/stress cardiomyopathy/mortality/risk factor分类
医药卫生
