控制营养状况评分在体外循环心脏术后不良结果预测中的价值分析

Value analysis of controlled nutritional status score in predicting adverse outcomes after cardiopulmonary bypass

目的探讨控制营养状况评分(COUNT评分)在成人体外循环心脏术后并发症及死亡率中的预测作用及临床意义。方法我院接受体外循环心脏手术的成年病人98例,根据COUNT评分中位数2分分为低营养风险组(≤2)和高营养风险组(≥3),对两组病人围手术期情况进行比较,分析早期并发症的危险因素,并评价COUNT评分对术后早期并发症及院内死亡的诊断价值。结果术后感染和急性肾损伤在高营养风险组中发生率较高(P<0.05),同时术后机械通气时间、ICU停留时间、术后住院时间在高营养风险组也较高(P<0.05)。多因素分析结果表明,COUNT评分、冠心病是术后早期并发症的独立危险因素(P<0.05)。ROC曲线表明,COUNT评分能较好预测术后早期并发症(AUC为0.677,最佳截止点为2.5)及院内死亡(AUC为0.873,最佳截止点为4.5)的发生。结论COUNT评分可能是一个有效预测接受体外循环心脏手术病人早期不良临床结果的术前营养评估工具。

Objective To investigate the predictive role and clinical significance of control nutritional status score(COUNT score)in postoperative complications and mortality in adults undergoing cardiopulmonary bypass.Methods A total of 98 adult patients undergoing cardiopulmonary bypass in our hospital were retrospectively analyzed.According to the median 2 of count score,they were divided into low nutritional risk group(≤2)and high nutritional risk group(≥3).The perioperative conditions of the two groups were compared,the risk factors of early complications were analyzed,and the diagnostic value of count score for early postoperative complications and hospital death was evaluated.Results The incidence of postoperative infection and acute kidney injury was higher in the high nutritional risk group(P<0.05),and the time of postoperative mechanical ventilation,ICU stay and postoperative hospital stay were also higher in the high nutritional risk group(P<0.05).Multivariate analysis showed that count score and coronary heart disease were independent risk factors for early postoperative complications(P<0.05).ROC curve showed that count score could predict early postoperative complications(AUC=0.677,the best cut-off point was 2.5)and in-hospital death(AUC=0.873,the best cut-off point was 4.5).Conclusion Count score may be an effective preoperative nutritional assessment tool for predicting early adverse clinical outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass.