心肌肌钙蛋白Ⅰ水平对非心脏手术后心肌损伤患者脱离机械通气的预测价值

目的:评估心肌肌钙蛋白I(cTnI)对非心脏术后心肌损伤患者脱离机械通气(简称脱机)的预测价值。方法:前瞻性观察2016年1月至2018年12月间我院收治的286例非心脏手术后心肌损伤(MINS)患者资料,比较脱机成功组(n=205)患者和脱机失败组(n=81)患者基本临床资料、既往病史、急性生理和慢性健康评分Ⅱ(APACHEⅡ)、手术情况、术后氧合以及cTnI水平等多个指标。采用多因素回归分析MINS患者脱机失败的危险因素,采用受试者工作特征曲线(ROC)评价cTnI水平对患者脱机的预测价值。结果:脱机失败组患者的cTnI水平显著高于脱机成功患者2.04(0.20,10.05)ng/ml vs 0.11(0.05,0.55)ng/ml,P<0.001]。对两组患者多个脱机相关指标进行多因素回归分析,结果显示,APACHEⅡ评分高(OR=1.086,95%CI:1.009~1.168;P=0.027)和cTnI水平升高(OR=1.462,95%CI:1.264~1.692;P<0.001)是MINS患者脱机失败的独立危险因素。ROC曲线分析显示,cTnI水平预测脱机失败的AUC为0.760,若cTnI水平联合APACHEⅡ评分预测,则AUC为0.763。结论:cTnI水平是MINS患者脱机失败的独立危险因素,对脱机失败有预测价值。

Value of Cardiac Troponin I Level on Predicting Weaning Failure in Patients With Myocardial Injury After Non-cardiac Surgery

Objectives:To assess the value of cardiac troponin I(cTnI)on predicting weaning failure in patients with myocardial injury after non-cardiac surgery(MINS).Methods:We prospective analyzed clinical data of 286 MINS patients admitted in our hospital from January 2016 to December 2018.These patients were divided into two groups:weaning success group(n=205)and weaning failure group(n=81).cTnI level was measured after the surgery once a day.The general clinical data,previous history,acute physiology and chronic health evaluation(APACHE)II score,mechanical time and respiratory related indexes and the rate of weaning failure were compared between the groups.Risk factors for weaning failure were determined by multivariable regression analysis.Predictive value of cTnI level for weaning failure was assessed by receiver operating curve(ROC).Results:Compared with weaning success group,cTnI level was significantly higher in the weaning failure patients.Multivariate analysis showed that APACHE II score(OR=1.086,P=0.027)and cTnI level(OR=1.462,P<0.001)were the independent risk factors of weaning failure.AUC of ROC of cTnI for predicting weaning failure was 0.760,AUC with the combination of cTnI and APACHE II score was 0.763.Conclusions:cTnI level and APACHE II score are the independent risk factors of weaning failure in MINS patients.cTnI level could be used to predict weaning failure in this patient cohort.