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血浆晶体渗透压与急性ST段抬高型心肌梗死患者短期预后的关系

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摘要:

目的 探究血浆晶体渗透压对心血管重症病房中急性ST段抬高型心肌梗死(STEMI)患者
短期预后的影响。方法 纳入2018年3月至2021年3月于徐州医科大学附属医院CCU住院的STEMI患者,研
究变量为血浆晶体渗透压。临床终点为院内全因死亡率。分析包括Lowess曲线,Logistic多元回归模型,
受试者工作特征曲线(ROC曲线)。结果 该研究总共纳入符合条件的STEMI患者582例。Lowess曲线和
条形图显示血浆晶体渗透压与STEMI患者的院内全因死亡率呈U型关系,在调整与院内全因死亡率相关
的临床特征后,血浆晶体渗透压是STEMI患者死亡率的独立预测因子(OR=1.06,95%CI:1.04~1.09,P
<0.001)。ROC曲线显示血浆晶体渗透压水平对于STEMI患者院内死亡率具有一定的预测价值,AUC为
0.70(95%CI:0.64~0.75,P<0.01)。结论 在心血管重症病房的STEMI患者中,血浆晶体渗透压可能
是其院内全因死亡率的独立危险因素,同时发现血浆晶体渗透压与STEMI患者院内全因死亡率呈U型关
系,对于其院内死亡率具有较高的预测价值。

Abstract:

Objective To investigate the influence of plasma crystalloid osmolality on short-term prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) in intensive care unit (ICU) of cardiovascular diseases. Methods STEMI patients in ICU were chosen from the Affiliated Hospital of Xuzhou Medical University from Mar. 2018 to Mar. 2021 and study variable was plasma crystalloid osmolality. The clinical end-point event was in-hospital all-cause mortality. The relationship between plasma crystalloid osmolality and in-hospital mortality was analyzed by using Lowess curve and bar chart. The data screened by single-factor analysis with difference with statistical significance was given a multi-factor Logistic regression analysis. Finally the predictive value of plasma crystalloid osmolality was reviewed by using ROC curve. Results There were 582 eligible patients with STEMI included in the study. Lowess curve and bar chart showed that there was a U-shaped relationship between plasma crystalloid osmolality and in-hospital all-cause mortality in STEMI patients. After corrected the clinical features related to in-hospital all-cause mortality, plasma crystalloid osmolality still was an independent predictive factor of mortality in STEMI patients (OR=1.06, 95%CI: 1.04~1.09, P<0.001). The results of ROC curve analysis showed that plasma crystalloid osmolality had some predictive value to in-hospital all-cause mortality in STEMI patients, and AUC was 0.70 (95%CI: 0.64~0.75, P<0.01). Conclusion Plasma crystalloid osmolality may be an independent risk factor of in-hospital all-cause mortality in STEMI patients in ICU. There is a U-shaped relationship between plasma crystalloid osmolality and in-hospital all-cause mortality, which has a higher predictive value to in-hospital mortality.

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