婴儿先天性心脏病手术后冠状动脉灌注压与院内结局之间的非线性关系
Nonlinear Relationship Between Coronary Perfusion Pressure and In-Hospital Outcomes After Infant Congenital Heart Surgery.
作者信息
Ge Tongkai, Luo Dandong, Wang Qiuji, Chen Jimei, Huang Huanlei, Zhang Chongjian
机构信息
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China.
出版信息
Children (Basel). 2024 Nov 24;11(12):1419. doi: 10.3390/children11121419.
OBJECTIVES
Our goal was to evaluate the associations between postoperative coronary perfusion pressure (CPP) values and in-hospital outcomes in infants after congenital cardiac surgery. Our goal was to assess the relationship between postoperative coronary perfusion pressure (CPP) values and in-hospital outcomes in infants following congenital cardiac surgery.
METHODS
In this study, we conducted a retrospective analysis on a cohort of 296 consecutive infant patients (aged 31-120 days) who underwent congenital cardiac surgery between 1 January 2019 and 30 April 2019. A total of 208 patients undergoing congenital cardiac surgery were included. The primary poor in-hospital outcome was prolonged recovery. The association between CPP level and in-hospital outcomes was determined using logistic regression analysis. We also used restricted cubic splines (RCSs) to evaluate the nonlinear relationship.
RESULTS
Our study included 208 participants, among whom the mortality rate was 1%. Prolonged hospital length of stay (LOS) was defined as more than 15 days, prolonged mechanical ventilation (MV) stay as more than 96 h, and prolonged intensive care unit (ICU) LOS as more than 403 h. In univariate analyses, we found that prolonged recovery was associated with both low CPP levels ( < 0.001, OR 4.28, 95% CI 1.94-9.46) and high CPP levels ( = 0.003, OR 3.39, 95% CI 1.52-7.58). In multivariable logistic regression analysis, after full adjustment, low CPP levels and high CPP levels were significantly associated with prolonged recovery ( = 0.005, OR = 3.72, 95% CI 1.48-9.35 and < 0.001, OR = 6.04, 95% CI 2.32-15.72, respectively). We observed that the relationship between CPP level and poor in-hospital outcomes was U-shaped in a two-piecewise linear regression analysis. We found that the inflection point of CPP level for prolonged recovery was 47 mm Hg.
CONCLUSION
The CPP levels exhibited a nonlinear relationship with poor in-hospital outcomes.
目的
我们的目标是评估先天性心脏手术后婴儿的术后冠状动脉灌注压（CPP）值与院内结局之间的关联。我们的目标是评估先天性心脏手术后婴儿的术后冠状动脉灌注压（CPP）值与院内结局之间的关系。
方法
在本研究中，我们对2019年1月1日至2019年4月30日期间连续接受先天性心脏手术的296例婴儿患者（年龄31 - 120天）进行了回顾性分析。共纳入208例接受先天性心脏手术的患者。主要的不良院内结局是恢复时间延长。使用逻辑回归分析确定CPP水平与院内结局之间的关联。我们还使用受限立方样条（RCS）来评估非线性关系。
结果
我们的研究包括208名参与者，其中死亡率为1%。住院时间延长（LOS）定义为超过15天，机械通气（MV）时间延长定义为超过96小时，重症监护病房（ICU）住院时间延长定义为超过403小时。在单因素分析中，我们发现恢复时间延长与低CPP水平（<0.001，OR 4.28，95%CI 1.94 - 9.46）和高CPP水平（=0.003，OR 3.39，95%CI 1.52 - 7.58）均相关。在多变量逻辑回归分析中，经过全面调整后，低CPP水平和高CPP水平均与恢复时间延长显著相关（分别为=0.005，OR = 3.72，95%CI 1.48 - 9.35和<0.001，OR = 6.04，95%CI 2.32 - 15.72）。在两段式线性回归分析中，我们观察到CPP水平与不良院内结局之间的关系呈U形。我们发现恢复时间延长的CPP水平拐点为47 mmHg。
结论
CPP水平与不良院内结局呈非线性关系。
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