急性肺栓塞患者右心功能不全的相关预测指标研究

发布时间：2018-04-19 16:18

本文选题：急性肺栓塞 + 右心功能不全　；参考：《中国全科医学》2017年31期

【摘要】：目的探讨急性肺栓塞(APE)患者右心功能不全(RVD)的相关预测指标。方法选取2013年7月—2016年9月于中国医科大学附属盛京医院确诊的符合纳入排除标准的APE患者127例,采用心脏超声评价入选患者是否有RVD,将入选患者分为RVD(+)组51例和RVD(-)组76例。收集入选患者的一般人口学资料、入院时心率、D-二聚体(D-dimer)水平、红细胞分布宽度(RDW)、脑钠肽前体及肌钙蛋白Ι情况,比较两组间差异。采用Logistic回归分析探讨APE合并RVD的影响因素;采用受试者工作特征(ROC)曲线评价指标对APE合并RVD的预测价值。结果 RVD(-)组与RVD(+)组入院时心率、D-dimer水平、肌钙蛋白Ι阳性率及脑钠肽前体阳性率比较,差异有统计学意义(P0.05);性别、年龄、RDW比较,差异无统计学意义(P0.05)。Logistic回归分析表明:入院时心率、肌钙蛋白I及脑钠肽前体是APE合并RVD的影响因素(P0.05)。ROC曲线分析表明,入院时心率对于APE合并RVD预测的曲线下面积为0.726[95%CI(0.673,0.815),P0.001],最佳截断值为89次/min,灵敏度为66.7%,特异度为75.0%。结论心率、肌钙蛋白Ι、脑钠肽前体对APE患者合并RVD存在影响。当APE患者入院时心率≥89次/min、肌钙蛋白Ι阳性、脑钠肽前体阳性时要高度怀疑患者存在RVD,需要严密监控。
[Abstract]:Objective to investigate the predictors of right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE).Methods from July 2013 to September 2016, 127 patients with APE diagnosed in Shengjing Hospital affiliated to China Medical University were selected.The patients were divided into two groups: RVD (51 cases) and RVD- (76 cases).The general demographic data of the selected patients were collected, the heart rate and D-dimer level, the RDWN distribution width of erythrocytes, the precursor of brain natriuretic peptide and troponin I at admission were compared between the two groups.Logistic regression analysis was used to study the influencing factors of APE combined with RVD, and the predictive value of the evaluation index of operating characteristics of subjects to APE combined with RVD was evaluated.Results there were significant differences in heart rate D-dimer, troponin I positive rate and brain natriuretic peptide precursor positive rate between RVD- group and RVD- group at admission.Logistic regression analysis showed that heart rate, troponin I and brain natriuretic peptide precursors were the influencing factors of APE with RVD.At admission, the area under the curve of APE combined with RVD prediction was 0.726 [95CIG 0.673 + 0.815N P0.001], the best truncation value was 89 times / min, the sensitivity was 66.7%, and the specificity was 75.0%.Conclusion Heart rate, troponin I and brain natriuretic peptide precursor have influence on RVD in patients with APE.When the heart rate of APE patients was more than 89 beats / min, troponin I was positive, and brain natriuretic peptide precursors were highly suspicious of the presence of RVDs, which should be closely monitored.
【作者单位】：中国医科大学附属盛京医院;
【分类号】：R563.5

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