区域氧饱和度在急性下肢缺血患者预后评估中的应用价值

Application value of regional oxygen saturation in prognosis evaluation of patients with acute lower limb ischemia

目的探讨区域氧饱和度(regional oxygen saturation,rSO2)水平在急性下肢缺血(acute lower limb ischemia,ALLI)患者预后评估中的应用价值。方法回顾性分析2021年6月至2022年6月新疆维吾尔自治区人民医院ICU收治的ALLI患者的临床资料,根据随访期间是否发生不良事件分为事件组和非事件组,比较两组患者的一般临床资料。采用多元逐步线性回归分析rSO2相关的独立预测因子;采用多因素Cox回归模型分析不良事件发生的独立危险因素;采用受试者工作特征(ROC)曲线获得rSO2预测不良事件的最佳截断值;根据最佳截断值将研究对象分为高值组和低值组,采用Kaplan-Meier曲线分析随访期间组间生存率差异。结果共有82例ALLI患者纳入此次研究,随访期间不良事件发生率为25.6%(21例);事件组患者术后四个时段rSO2、24 h rSO2最大值、最小值、平均值及踝肱指数均明显低于非事件组;肌钙蛋白I、肌钙蛋白T、肌红蛋白、肌酸激酶、C反应蛋白及乳酸水平显著高于非事件组,差异具有统计学意义(均P<0.05)。多元逐步线性回归分析结果显示:C反应蛋白(β=-0.320,P=0.002)、血浆乳酸(β=-0.262,P=0.009)、肌钙蛋白Ⅰ(β=-0.230,P=0.025)、吸烟史(β=-0.211,P=0.034)均是rSO2的独立预测因子。多因素Cox回归分析结果显示:24 h rSO2平均值是ALLI患者发生不良事件的独立影响因素(校正后HR=0.67,95%CI:0.54~0.83,P<0.001)。24 h rSO2平均值对ALLI患者术后30 d、60 d和90 d发生不良事件均具有较好的预测价值(AUC分别为0.934、0.867及0.823),对应的rSO2最佳截断值分别为59.36%,59.03%及59.03%。以24 h rSO2平均值为59.36作为最佳截断值预测ALLI患者术后发生不良事件的敏感度和特异度分别为85.7%和85.3%。根据最佳截断值将研究对象分为高值组(rSO2>59.36%,59例)和低值组(rSO2≤59.36%,23例),Kaplan-Meier生存曲线分析结果显示:两组间无事件生存率差异具有统计学意义(P<0.001),高值组明显优于低值组。结论24 h rSO2平均值是ALLI患者术后发生不良事件的独立影响因素,对ALLI患者的预后具有良好的预测价值。

Objective To explore the application value of regional oxygen saturation(rSO2)level in the prognosis evaluation of patients with acute lower limb ischemia(ALLI).Methods Retrospective analysis of clinical data of 82 ALLI patients admitted to the ICU of Xinjiang Uygur Autonomous Region People's Hospital from June 2021 to June 2022.The subjects were divided into event group and nonevent group according to the incidence of adverse events during the follow-up.The general clinical data of the two groups were compared.Multiple stepwise linear regression was used to analyze the independent related factors of rSO2.Multivariate Cox regression was used to analyze independent risk factors of adverse events.Receiver operating characteristic(ROC)curve was used to obtain the optimal cut-off value of rSO2 prediction adverse events.The subjects were divided into high-value group and low-value group according to the optimal cut-off value.Kaplan-Meier curve was used to analyze the difference in survival rate between groups during the follow-up.Results A total of 82 ALLI patients were included in this study,and the incidence of adverse events during follow-up was 25.6%(21 cases).The rSO2 of four periods and maximum,minimum,average and ankle-brachial index in the event group were significantly lower than those in the non-event group.The troponin I,troponin T,myoglobin,creatine kinase,C-reactive protein,and lactate in the event group were significantly higher than those in the non event group(P˂0.05).Multiple stepwise linear regression analysis showed that:C-reactive protein(β=-0.320,P=0.002),lactate(β=-0.262,P=0.009),troponinⅠ(β=-0.230,P=0.025),and smoking history(β=-0.211,P=0.034)were all independent predictors of rSO2.Multivariate Cox regression analysis showed that 24 h rSO2(mean)was an independent influencing factor for adverse events in ALLI patients(adjusted HR=0.67,95%CI:0.54-0.83,P<0.001).The 24 h rSO2(mean)was good in predicting the incidence of adverse events at 30,60,and 90 days in ALLI patients(AUC were 0.934,0.867 and 0.823),and the corresponding optimal cutoff values of rSO2 were 59.36,59.03 and 59.03.The sensitivity and specificity to predict adverse events in ALLI patients were 85.7%and 85.3%when the 24 h rSO2(mean)was 59.36 as the best cut-off value.According to the optimal cut-off,the subjects were divided into high value group(rSO2>59.36%,59 cases)and low value group(rSO2≤59.36%,23 cases),Kaplan Meier survival curve analysis showed that there was significant difference in event free survival between the two groups(P<0.001),the high value group significantly better than the low value group.Conclusion The 24 h rSO2(mean)is an independent influencing factor for adverse events in ALLI patients,and has good predictive value for prognosis.