非体外循环冠脉搭桥术后早期重度低氧血症的风险预测模型探索

A prediction model for severe early postoperative hypoxemia after Off-pump coronary artery graft

目的 探讨非体外循环冠状动脉搭桥术（OPCABG）后早期重度低氧血症（POH）的独立危险因素,并建立相应的危险预测模型.方法 回顾性分析上海交通大学医学院附属新华医院心胸外科自2010年6月至2015年6月连续开展的420例OPCABG患者临床资料,根据术后48 h内是否出现重度POH分为重度POH组和非重度POH组,应用单因素分析和二元Logisitic回归分析,得出早期重度POH的独立危险因素.利用得到的独立危险因素建立风险预测模型,采集2015年7月至2016年8月行OPCABG术患者的临床资料,应用ROC曲线和Hosmer Lemeshow拟合优度检验对该风险预测模型进行检验.结果 46例术后48 h内出现重度POH,发生率为10.95%.二元Logisitic回归分析提示,年龄、BMI、术前LVEF、术前血肌酐水平、急诊行OPCABG手术以及术后48 h内行二次关胸止血,是造成OPCABG术后48 h内重度POH的独立危险因素;并据此建立风险预测模型,预测模型ROC曲线下面积为0.771,Hosmer Lemeshow拟合优度检验P值为0.725.结论 本研究建立的风险预测模型能较好地预测OPCABG术后早期重度POH的发生风险.

Objective To study the risk factors of severe early postoperative hypoxemia after off-pump coronary artery graft,and establish a prediction model. Methods Data of 420 consecutive patients from June 2010 to June 2015,who underwent off-pump coronary artery graft in the department of cardiothoracic surgery of Xinhua Hospital,were retrospectively analyzed. All the cases were divided into two groups according to the appear-ance of severe postoperative hypoxemia. All the data about potential risk factors was put into the database and ana-lyzed by logistic regression. The prediction model was then established upon acquired independent risk factors. Dis-crimination and calibration of the prediction model were assessed with ROC curve and Hosmer and Lemeshow goodness of fit test. Results 46 postoperative hypoxemia happened in 69 cases within 48 hours after procedures, with an incidence rate of 10.95%. The logistic regression demonstrated that age,BMI,preoperative ejection fac-tion,preoperative serum myoglobin,emergent off-pump coronary artery graft,and re-exploration within 48 hours after procedures were the independent risk factors for severe postoperative hypoxemia. The prediction model was then established based on these independent risk factors. The area under ROC curve of the model was 0.771,and the P value in Hosmer and Lemeshow goodness of fit test was 0.725. Conclusion The logsitic model built in this study succeeded to predict the incidence of severe postoperative hypoxemia after off-pump coronary artery graft, and it could meet the doctors′ requirement with its excellent discrimination and calibration.