目的 急性心肌梗死患者直接PCI术后合并肠梗阻的预测因素,并建立预测模型.方法 回顾分析2004年6月至2014年6月期间行直接PCI术的患者共计1220例,其中符合入选、排除标准的1 025例,将入选的1 025例患者用SPSS17.0软件产生随机数字并随机分为2个队列,其中排序前2/3为模型产生队列,后1/3为模型验证队列.根据模型产生队列是否发生肠梗阻又分成肠梗阻组和对照组并分析肠梗阻的临床特点.将肠梗阻组与对照组比较后,差异具有统计学意义的参数纳入单因素Logistic回归分析,对有统计学意义的参数再进一步行多因素Logistic回归分析,从而确定预测因素.按β回归系数所占的比重,对预测因素给予赋值,建立评分模型,采用ROC曲线在模型验证队列中评价评分模型的预测能力.结果 1 025例患者中共有103例患者发生不同类型肠梗阻,发生率约10.0％,肠梗阻类型以低位、不全性及单纯性肠梗阻为主.多因素Logistic回归分析显示,年龄＞ 65岁(OR=1.44,95％CI:1.26～4.63,P=0.000)、糖尿病(OR=3.37,95％ CI:2.39～9.47,P=0.000)、便秘习惯(OR=4.75,95％ CI:3.58 ～ 11.24,P=0.024)、下壁和广泛前壁部位心梗(OR=2.16,95％ CI:1.94-4.79,P=0.017)、心功能≥3级(killip分级)(OR=2.86,95％ CI:1.98 ～ 5.67,P=0.002)、经股动脉穿刺(OR=2.76,95％ CI:1.38 ～ 6.12,P=0.002)、K+＜3.5 mmol/L(OR=1.86,95％CI:1.11 ～ 5.47,P=0.005)、通便药(OR=3.59,95％ CI:2.99～10.21,P=0.000)及吗啡使用(OR=1.98,95％ CI:1.07-3.12,P=0.021)及eGFR ＜60 mL·min-1.1.73m-2(OR=1.19,95％CI:1.10 ～3.22,P=0.031)是AMI患者直接PCI术后并发肠梗阻的预测因素.受试者工作特征(ROC曲线)证实根据这些因素建立的评分模型对AMI患者直接PCI术后肠梗阻的发生具有较好的预测准确性(AUC =0.815,95％ CI:0.802～0.883,P=0.000).结论 年龄＞65岁、糖尿病、便秘习惯、下壁和广泛前壁部位心梗、心功能≥3级(killip分级)、经股动脉穿刺、K+＜3.5 mmol/L、通便药及吗啡使用及eGFR ＜60 mL· min-1·1.73m-2是AMI患者直接PCI术后并发肠梗阻的预测因素.由此建立的评分模型对直接PCI术后发生肠梗阻具有良好的预测能力.
目的 急性心肌梗死患者直接PCI術後閤併腸梗阻的預測因素,併建立預測模型.方法 迴顧分析2004年6月至2014年6月期間行直接PCI術的患者共計1220例,其中符閤入選、排除標準的1 025例,將入選的1 025例患者用SPSS17.0軟件產生隨機數字併隨機分為2箇隊列,其中排序前2/3為模型產生隊列,後1/3為模型驗證隊列.根據模型產生隊列是否髮生腸梗阻又分成腸梗阻組和對照組併分析腸梗阻的臨床特點.將腸梗阻組與對照組比較後,差異具有統計學意義的參數納入單因素Logistic迴歸分析,對有統計學意義的參數再進一步行多因素Logistic迴歸分析,從而確定預測因素.按β迴歸繫數所佔的比重,對預測因素給予賦值,建立評分模型,採用ROC麯線在模型驗證隊列中評價評分模型的預測能力.結果 1 025例患者中共有103例患者髮生不同類型腸梗阻,髮生率約10.0％,腸梗阻類型以低位、不全性及單純性腸梗阻為主.多因素Logistic迴歸分析顯示,年齡＞ 65歲(OR=1.44,95％CI:1.26～4.63,P=0.000)、糖尿病(OR=3.37,95％ CI:2.39～9.47,P=0.000)、便祕習慣(OR=4.75,95％ CI:3.58 ～ 11.24,P=0.024)、下壁和廣汎前壁部位心梗(OR=2.16,95％ CI:1.94-4.79,P=0.017)、心功能≥3級(killip分級)(OR=2.86,95％ CI:1.98 ～ 5.67,P=0.002)、經股動脈穿刺(OR=2.76,95％ CI:1.38 ～ 6.12,P=0.002)、K+＜3.5 mmol/L(OR=1.86,95％CI:1.11 ～ 5.47,P=0.005)、通便藥(OR=3.59,95％ CI:2.99～10.21,P=0.000)及嗎啡使用(OR=1.98,95％ CI:1.07-3.12,P=0.021)及eGFR ＜60 mL·min-1.1.73m-2(OR=1.19,95％CI:1.10 ～3.22,P=0.031)是AMI患者直接PCI術後併髮腸梗阻的預測因素.受試者工作特徵(ROC麯線)證實根據這些因素建立的評分模型對AMI患者直接PCI術後腸梗阻的髮生具有較好的預測準確性(AUC =0.815,95％ CI:0.802～0.883,P=0.000).結論 年齡＞65歲、糖尿病、便祕習慣、下壁和廣汎前壁部位心梗、心功能≥3級(killip分級)、經股動脈穿刺、K+＜3.5 mmol/L、通便藥及嗎啡使用及eGFR ＜60 mL· min-1·1.73m-2是AMI患者直接PCI術後併髮腸梗阻的預測因素.由此建立的評分模型對直接PCI術後髮生腸梗阻具有良好的預測能力.
목적 급성심기경사환자직접PCI술후합병장경조적예측인소,병건립예측모형.방법 회고분석2004년6월지2014년6월기간행직접PCI술적환자공계1220례,기중부합입선、배제표준적1 025례,장입선적1 025례환자용SPSS17.0연건산생수궤수자병수궤분위2개대렬,기중배서전2/3위모형산생대렬,후1/3위모형험증대렬.근거모형산생대렬시부발생장경조우분성장경조조화대조조병분석장경조적림상특점.장장경조조여대조조비교후,차이구유통계학의의적삼수납입단인소Logistic회귀분석,대유통계학의의적삼수재진일보행다인소Logistic회귀분석,종이학정예측인소.안β회귀계수소점적비중,대예측인소급여부치,건립평분모형,채용ROC곡선재모형험증대렬중평개평분모형적예측능력.결과 1 025례환자중공유103례환자발생불동류형장경조,발생솔약10.0％,장경조류형이저위、불전성급단순성장경조위주.다인소Logistic회귀분석현시,년령＞ 65세(OR=1.44,95％CI:1.26～4.63,P=0.000)、당뇨병(OR=3.37,95％ CI:2.39～9.47,P=0.000)、편비습관(OR=4.75,95％ CI:3.58 ～ 11.24,P=0.024)、하벽화엄범전벽부위심경(OR=2.16,95％ CI:1.94-4.79,P=0.017)、심공능≥3급(killip분급)(OR=2.86,95％ CI:1.98 ～ 5.67,P=0.002)、경고동맥천자(OR=2.76,95％ CI:1.38 ～ 6.12,P=0.002)、K+＜3.5 mmol/L(OR=1.86,95％CI:1.11 ～ 5.47,P=0.005)、통편약(OR=3.59,95％ CI:2.99～10.21,P=0.000)급마배사용(OR=1.98,95％ CI:1.07-3.12,P=0.021)급eGFR ＜60 mL·min-1.1.73m-2(OR=1.19,95％CI:1.10 ～3.22,P=0.031)시AMI환자직접PCI술후병발장경조적예측인소.수시자공작특정(ROC곡선)증실근거저사인소건립적평분모형대AMI환자직접PCI술후장경조적발생구유교호적예측준학성(AUC =0.815,95％ CI:0.802～0.883,P=0.000).결론 년령＞65세、당뇨병、편비습관、하벽화엄범전벽부위심경、심공능≥3급(killip분급)、경고동맥천자、K+＜3.5 mmol/L、통편약급마배사용급eGFR ＜60 mL· min-1·1.73m-2시AMI환자직접PCI술후병발장경조적예측인소.유차건립적평분모형대직접PCI술후발생장경조구유량호적예측능력.
Objective to determine predictive factors of intestinal obstruction in acute myocardial infraction (AMI) patients after primary percutaneous coronary intervention (PCI) and to establish predictive model.Methods A total of 1220 AMI patients underwent primary PCI in Jiangxi provincial people's hospitalfrom June2004 toJune 2014were retrospectively analyzed.And 1025 cases of them whichall met the inclusion and exclusion criteriawere randomlydivided by using random number generated by SPSS 17.0 into two cohorts:model derivation cohort (MDC) and model validation cohort (MVC).MDC was divided into intestinal obstruction group and control group.predictive factors were identified using univariable andmultivariable logistic regression analysis in MDC.Interger point values were assigned to each predictor based upon their coefficient in multivariable logistic regression model to establish scoring model.The summed scores of each case in MVC were calculated to test predictive ability of the model by ROC cure.Results Total of 1 025 patients,103 patients were diagnosed with different types of intestinal obstruction and the incidence of intestinal obstruction was 10.0％.Low position intestinal obstruction,incomplete intestinal obstruction and simple intestinal obstructionwere main characteristics in these patients.logistic regression analysis identified ten risk factorscan predict the appearance of intestinal obstruction:age ＞ 65years old (OR =1.44,95％ CI:1.26-4.63,P =0.000),diabetes mellitus (OR =3.37,95％ CI:2.39-9.47,P =0.000),habitual constipation (OR =4.75,95 ％ CI:3.58-11.24,P =0.024),inferior and extensive anterior wall myocardial infarction (OR =2.16,95％ CI:1.94-4.79,P =0.017),cardiac functiongrade≥3 class (Killip classification) (OR=2.86,95％CI:1.98-5.67,P=0.002),femoral approach (OR=2.76,95％CI:1.38-6.12,P=0.002),K+ ＜3.5 mmol/L (OR=1.86,95％CI:1.11-5.47,P =0.005),taking laxative (OR =3.59,95％ CI:2.99-10.21,P =0.000),using morphine (OR =1.98,95％ CI:1.07-3.12,P =0.021) and estimated glomerular filtration rate (eGFR) ＜60 mL · min-1 · 1.73m-2 (OR =1.19,95％ CI:1.10-3.22,P =0.031).and areas under the ROC cure was 0.815 (95％ CI:0.802-0.883,P =0.000) and indicating the accuracy of predicting intestinal obstruction.Conclusions age ＞ 65 years old,diabetes mellitus,habitual constipation,inferior and extensive anterior parts of myocardial infarction,cardiac functiongrade ≥3class (Killip classification),femoral approach,K + ＜3.5mmol/L,taking laxative,using morphine and eGFR ＜ 60 ml.min-1.1.73m2 were important predictive factors for intestinal obstruction in AMI patients after underwent 0 and the scoring model can predict accurately intestinal obstruction in such patients.
