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高敏肌钙蛋白T作为心脏瓣膜手术患者重症监护病房住院时间延长及治疗结果较差的预测指标

High-Sensitivity Troponin T as a Predictor of Prolonged Intensive Care Unit Stay and Worse Treatment Outcomes in Patients Undergoing Heart Valve Surgery.

作者信息

Duchnowski Piotr, Śmigielski Witold, Kołsut Piotr

机构信息

Cardinal Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland.

出版信息

J Clin Med. 2025 Jul 15;14(14):4989. doi: 10.3390/jcm14144989.

Abstract

Prolonged stays in the postoperative intensive care unit (ICU) for patients undergoing heart valve surgery are mainly caused by the development of complications. In turn, with the extension of the ICU stay, there is a risk of developing further serious postoperative complications. The main aim of the present study was to evaluate selected biomarkers in terms of their predictive potential for a prolonged postoperative stay in the ICU. This prospective study was conducted on a group of patients undergoing heart valve surgery. The primary endpoint was prolonged postoperative intensive care unit stay beyond 3 days (above the median). Logistic regression analysis was used to assess the predictors of the occurrence of the primary endpoint. A total of 631 patients were included in the study. The median stay in the ICU was 3 days (2-5). A total of 265 patients required a prolonged stay in the ICU. In multivariate logistic regression analysis troponin T measured before surgery ( = 0.014), EuroSCORE II operative risk score ( = 0.004), troponin T measured the day after surgery ( = 0.005), preoperative RDW level ( = 0.005) and the presence of preoperative atrial fibrillation ( = 0.002) were independent predictors of the primary endpoint. Patients with elevated troponin T values determined both before the procedure and in the early postoperative period should be given special attention, because this group of patients is burdened with an increased risk of prolonged stay in the postoperative ward, the occurrence of serious postoperative complications and ultimately worse prognosis.

摘要

接受心脏瓣膜手术的患者在术后重症监护病房(ICU)停留时间延长主要是由并发症的发生引起的。反过来,随着在ICU停留时间的延长,又有发生进一步严重术后并发症的风险。本研究的主要目的是评估所选生物标志物对术后在ICU停留时间延长的预测潜力。这项前瞻性研究是在一组接受心脏瓣膜手术的患者中进行的。主要终点是术后在重症监护病房停留时间超过3天(超过中位数)。采用逻辑回归分析来评估主要终点发生的预测因素。共有631例患者纳入研究。在ICU的中位停留时间为3天(2 - 5天)。共有265例患者需要在ICU延长停留时间。在多因素逻辑回归分析中,术前肌钙蛋白T(P = 0.014)、欧洲心脏手术风险评估系统II(EuroSCORE II)手术风险评分(P = 0.004)、术后第1天的肌钙蛋白T(P = 0.005)、术前红细胞分布宽度(RDW)水平(P = 0.005)以及术前心房颤动的存在(P = 0.002)是主要终点的独立预测因素。术前和术后早期肌钙蛋白T值升高的患者应给予特别关注,因为这组患者术后在病房延长停留时间、发生严重术后并发症以及最终预后较差的风险增加。

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