术中血糖变异系数对非体外循环冠状动脉旁路移植术后肺部感染的预测价值

Predictive value of intraoperative glucose coefficient of variation for pulmonary infection after off-pump coronary artery bypass surgery

目的探讨非体外循环冠状动脉旁路移植术(OPCABG)患者术中血糖变异系数(CV)对术后发生肺部感染的预测价值。方法选取2017年1月—2022年7月徐州医科大学附属医院重症监护室收治的401例OPCABG术后患者。根据术后是否发生肺部感染,将上述患者分为感染组和非感染组。采用多因素Logistic回归分析筛选OPCABG患者术后发生肺部感染的独立危险因素。绘制受试者工作特征曲线(ROC),评估术中CV对OPCABG患者术后肺部感染的预测价值。结果本研究中OPCABG术后肺部感染的总发生率为23%。与非感染组相比,感染组患者术中CV水平显著升高(P<0.05)。此外2组乳酸(Lac)、中性粒细胞与淋巴细胞比值(NLR)、降钙素原(PCT)、白细胞介素6(IL-6)、并行其他手术、急性生理与慢性健康(APACHEⅡ)评分和总住院时间比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,术中CV、Lac、IL-6、并行其他手术、APACHEⅡ评分和总住院时间是OPCABG术后发生肺部感染的独立危险因素。ROC分析显示,术中CV预测OPCABG术后肺部感染的ROC曲线下面积(AUC)为0.719(95%CI 0.659~0.780),当术中CV的截断值为13.404%时,敏感度为0.641,特异度为0.699,约登指数为0.340。结论术中CV是OPCABG患者术后发生肺部感染的独立危险因素,可以作为术后并发肺部感染的预测指标。

Objective To explore the predictive value of intraoperative glucose coefficient of variation(CV)for pulmonary infection after off-pump coronary artery bypass surgery(OPCABG).Methods A total of 401 patients who were subject to OPCABG and admitted to the Intensive Care Unit,the Affiliated Hospital of Xuzhou Medical University from January 2017 to July 2022 were enrolled.According to the presence of postoperative pulmonary infection,they were divided into two groups:an infection group and a non-infection group.Multivariate logistic regression analysis was used to screen the independent risk factors for postoperative pulmonary infection in OPCABG patients.A receiver operator characteristic curve(ROC)was plotted to assess the predictive value of intraoperative CV for postoperative pulmonary infection in OPCABG patients.Results In the current study,the overall incidence of pulmonary infection after OPCABG was 23%.Compared with the non-infection group,the infection group showed significantly increased intraoperative CV levels(P<0.05).Furthermore,significant differences were found in lactic acid(Lac),neutrophil/lymphocyte count ratio(NLR),procalcitonin(PCT),interleukin-6(IL-6),concurrent other surgery,the Acute Physiology and Chronic Health Evaluation II(APACHE II)score and the total length of hospitalization stay between the two groups(P<0.05).According to multivariate logistic regression analysis,intraoperative CV,Lac,IL-6,concurrent other surgery,APACHE II score and the total length of hospitalization stay were the independent risk factors for pulmonary infection after OPCABG.Furthermore,the area under the ROC(AUC)of intraoperative CV in predicting pulmonary infection after OPCABG was 0.719(95%CI 0.659-0.780).When the cut-off value of intraoperative CV was 13.404%,the sensitivity was 0.641,the specificity was 0.699,and the Yordon index was 0.340.Conclusions Intraoperative CV is an independent risk factor for postoperative pulmonary infection in OPCABG patients and can be used as a predictive indicator.