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目的分析先天性心脏病患儿术后肌酸激酶同工酶(CK-MB)升高的影响因素及其对死亡事件的预测价值。方法回顾性分析2012年1月至2013年12月期间阜外心血管病医院708例体重低于15 kg行择期手术的先心病患儿的临床资料,其中男269例(38.0%)、女439例(62.0%)。CK-MB取术后住院期间最大值进行分析,按术后CK-MB最大值将患儿分为三组:A组(CK-MB≤25 IU/L),B组(25 IU/L125 IU/L)。结果紫绀型先心病(P=0.002)、主动脉阻断(P=0.030)、体外循环时间(P=0.002)、主动脉阻断时间(P=0.016)、二次转机(P<0.001)、深低温停循环(P=0.024)与术后CK-MB升高独立相关。三组间术后死亡率差异有统计学意义(均为P<0.001)。受试者工作特征(ROC)曲线表明CK-MB对术后住院死亡具有预测价值(P<0.001),最佳临界值为168.5 IU/L,该临界值点敏感度为54.2%,特异度为90.8%,阳性预测值为17.3%,阴性预测值为98.4%。多因素logistic回归表明CK-MB>168.5 IU/L是术后死亡的独立危险因素(OR=6.364,P<0.001)。结论小儿心脏术后CK-MB的升高受多个因素的影响,术后CK-MB重度升高的患儿术后死亡风险增加。
Objective To analyze the influencing factors of CK-MB in children with congenital heart disease (CHD) and their predictive value of death. Methods The clinical data of 708 patients with CHD who underwent selective elective operation at the Fuwai Hospital of Cardiovascular Diseases from January 2012 to December 2013 were retrospectively analyzed. Among them, 269 (38.0%) were male and 439 Example (62.0%). The maximum value of CK-MB during hospitalization was analyzed. According to the maximum CK-MB after operation, the children were divided into three groups: group A (CK-MB≤25 IU / L), group B (25 IU / L < CK-MB≤125 IU / L) and group C (CK-MB> 125 IU / L). Results Cyanotic congenital heart disease (P = 0.002), aortic blockage (P = 0.030), cardiopulmonary bypass time (P = 0.002), aortic blockade time (P = 0.016) Deep hypothermic circulatory arrest (P = 0.024) was independently associated with postoperative CK-MB elevation. There were significant differences in postoperative mortality among the three groups (all P <0.001). The receiver operating characteristic (ROC) curve showed that CK-MB had a predictive value for postoperative in-hospital mortality (P <0.001), the best cut-off value was 168.5 IU / L, the critical point sensitivity was 54.2% and the specificity 90.8%, positive predictive value was 17.3%, negative predictive value was 98.4%. Multivariate logistic regression showed that CK-MB> 168.5 IU / L was an independent risk factor for postoperative death (OR = 6.364, P <0.001). Conclusion The elevation of CK-MB in children after cardiac surgery is affected by many factors. The postoperative mortality of children with severe CK-MB increase after operation.