You Position: Home > Paper
Risk factors analysis of acute respiratory distress syndrome after cardiopulmonary bypass and construction of nomogram prediction model
( views:25, downloads:27 )
- Author:
- No author available
- Journal Title:
- China Medicine
- Issue:
- 2
- DOI:
- 10.3760/j.issn.1673-4777.2023.02.010
- Key Word:
- 体外循环术;急性呼吸窘迫综合征;预测模型;列线图
Abstract： 目的 探讨体外循环术后患者发生急性呼吸窘迫综合征(ARDS)的危险因素并构建列线图预测模型.方法 本研究为回顾性病例对照研究.纳入2005 年1 月至2015 年12 月入住首都医科大学附属北京安贞医院心脏外科在体外循环辅助下行心脏或大血管手术,并于术后发生ARDS的患者 145 例为ARDS组.根据每例ARDS患者的手术年份及年龄,随机匹配2 例体外循环辅助下行心脏或大血管手术后未发生ARDS的患者作为对照组(290 例).应用Logistic回归方法分析体外循环术后ARDS的危险因素,并应用列线图方法构建体外循环术后ARDS预测模型.结果 多因素Logistic回归分析结果显示,低术前血红蛋白水平(比值比 =0.98,95%置信区间:0.96~0.99,P = 0.001)、手术时间增加(比值比 = 1.26,95%置信区间:1.05~1.51,P=0.011)、术后第1 天高急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(比值比=1.14,95%置信区间:1.08~1.23,P<0.001)、吸烟(比值比=2.65,95%置信区间:1.14~6.05,P=0.023)、瓣膜联合冠状动脉旁路移植术(CABG)手术(比值比=2.59,95%置信区间:1.11~6.01,P=0.027)为体外循环辅助下行心脏或大血管手术患者术后发生ARDS的独立危险因素.将上述因素全部纳入预测模型构建列线图,该预测模型的曲线下面积为0.834,最佳阈值为0.334 时,特异度为0.814,敏感度为0.748.结论 低术前血红蛋白水平、手术时间增加、高APACHEⅡ评分、吸烟、瓣膜联合CABG手术为体外循环术后发生ARDS的独立危险因素.以这些危险因素构建的列线图预测模型可用于体外循环术后患者ARDS的早期识别.
- [1]J, McGuinness,D, Bouchier-Hayes,J M, Redmond.Understanding the inflammatory response to cardiac surgery.[J].2008,6(3).
- [2]Xue-Mei Zheng,Zhuo Yang,Guang-Li Yang,etc.Lung injury after cardiopulmonary bypass: Alternative treatment prospects[J].2022,(3).
- [3]Calfee CS,Matthay MA,Eisner MD,etc.Active and passive cigarette smoking and acute lung injury after severe blunt trauma.[J].2011,183(12).
- [4]Manjula.Sarkar,Vishal.Prabhu.Basics of cardiopulmonary bypass[J].2017,61(9).
- [5]Preisman,S.,Sternik,L.,Kogan,A.,etc.Adult respiratory distress syndrome following cardiac surgery[J].2014,29(1).
- [6]Damluji, Abdulla,Colantuoni, Elizabeth,Mendez-Tellez, Pedro A.,etc.Short-term mortality prediction for acute lung injury patients: External validation of the Acute Respiratory Distress Syndrome Network prediction model.[J].2011,39(5).
- [7]Julie L, Huffmyer,Danja S, Groves.Pulmonary complications of cardiopulmonary bypass.[J].2015,29(2).
- [8]Moazed, Farzad,Burnham, Ellen L.,Vandivier, R. William,etc.Cigarette smokers have exaggerated alveolar barrier disruption in response to lipopolysaccharide inhalation[J].2016,71(12).
- [9]Carlos Iribarren,David R. Jacobs Jr.,Stephen Sidney,etc.Cigarette Smoking, Alcohol Consumption, and Risk of ARDS: A 15-Year Cohort Study in a Managed Care Setting[J].2000,117(1).
- [10]Aljure, Oscar D.,Fabbro, Michael, II.Cardiopulmonary Bypass and Inflammation: The Hidden Enemy[J].2019,33(2).
- [11]Kor DJ,Warner DO,Alsara A,etc.Derivation and diagnostic accuracy of the surgical lung injury prediction model.[J].2011,115(1).
- [12]Vlaar AP,Hofstra JJ,Determann RM,etc.The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study.[J].2011,117(16).
- [13]Martínez-Rafael,B.,Tamayo,E.,Bermejo-Martin,J.F.,etc.Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery[J].2012,27(1).
- [14]Elie-Turenne Marie-Carmelle,Hou Peter C,Mitani Aya,etc.Lung injury prediction score for the emergency department: first step towards prevention in patients at risk[J].2012,5(1).
- [15]Ware,L.B.,Lee,J.W.,Wickersham,N.,etc.Donor smoking is associated with pulmonary edema, inflammation and epithelial dysfunction in ex vivo human donor lungs[J].2014,14(10).
- [16]S. Tandon.Peri‐operative risk factors for acute lung injury after elective oesophagectomy†[J].2001,86(5).
- [17]Trillo Alvarez C,Cartin Ceba R,Kor DJ,etc.Acute lung injury prediction score: derivation and validation in a population-based sample.[J].2011,37(3).
- [18]Sadikot R,Watkins TR,Festic E,etc.Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study.[J].2011,183(4).
- [19]Thompson,B.T.,Caldwell,E.,Slutsky,A.S.,etc.Acute respiratory distress syndrome: The Berlin definition[J].2012,307(23).
- [20]Huppert, Laura A.,Matthay, Michael A.,Ware, Lorraine B..Pathogenesis of Acute Respiratory Distress Syndrome[J].2019,40(1).