腹部重大急诊手术术前休克指数

IF 5.2 4区 医学 Q2 Medicine Annals Academy of Medicine Singapore Pub Date : 2023-09-27 DOI:10.47102/annals-acadmedsg.2023143
Celestine Jia Ling Loh, Ming Hua Cheng, Yuqing Shang, Nicholas Brian Shannon, Hairil Rizal Abdullah, Ke Yuhe
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引用次数: 0

摘要

简介:腹部大急诊手术(MAES)患者有很高的死亡率和并发症风险。MAES的时间敏感性需要一个易于计算的风险评分工具。休克指数(SI)是通过心率(HR)除以收缩压(SBP)得到的,可以深入了解患者的血流动力学状态。我们的目的是评估SI在预测术后死亡率、急性肾损伤(AKI)、重症监护病房(ICU)和高依赖性监测需求以及ICU住院时间(LOS)方面的有用性。方法:回顾性分析2013年1月至2020年12月期间212089例MAES患者。该队列倾向匹配,共纳入3960例患者。使用麻醉图中记录的第一次HR和收缩压计算SI。回归模型用于调查SI与结果之间的关系。用Kaplan-Meier曲线探讨SI与生存率的关系。结果:SI与死亡率在1个月时(比值比[OR] 2.40[1.67-3.39], 0.001)、3个月时(比值比[OR] 2.13[1.56-2.88], 0.001)和2年时(OR 1.77[1.38-2.25], 0.001)存在显著相关性。多因素分析显示,SI与1个月时(OR 3.51 [1.20-10.3], P=0.021)和3个月时(OR 3.05 [1.07-8.54], P=0.034)的死亡率有显著相关性。单因素和多因素分析也显示SI与AKI (P<0.001)、术后ICU入院(P<0.005)和ICU LOS (P<0.001)之间存在显著关系。SI对2年死亡率无显著影响。结论:SI可用于预测术后1个月、3个月死亡率、AKI、术后ICU入院及ICU LOS。
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Preoperative shock index in major abdominal emergency surgery
Introduction: Major abdominal emergency surgery (MAES) patients have a high risk of mortality and complications. The time-sensitive nature of MAES necessitates an easily calculable risk-scoring tool. Shock index (SI) is obtained by dividing heart rate (HR) by systolic blood pressure (SBP) and provides insight into a patient’s haemodynamic status. We aimed to evaluate SI’s usefulness in predicting postoperative mortality, acute kidney injury (AKI), requirements for intensive care unit (ICU) and high-dependency monitoring, and the ICU length of stay (LOS). Method: We retrospectively reviewed 212,089 MAES patients from January 2013 to December 2020. The cohort was propensity matched, and 3960 patients were included. The first HR and SBP recorded in the anaesthesia chart were used to calculate SI. Regression models were used to investigate the association between SI and outcomes. The relationship between SI and survival was explored with Kaplan-Meier curves. Results: There were significant associations between SI and mortality at 1 month (odds ratio [OR] 2.40 [1.67–3.39], P<0.001), 3 months (OR 2.13 [1.56–2.88], P<0.001), and at 2 years (OR 1.77 [1.38–2.25], P<0.001). Multivariate analysis revealed significant relationships between SI and mortality at 1 month (OR 3.51 [1.20–10.3], P=0.021) and at 3 months (OR 3.05 [1.07–8.54], P=0.034). Univariate and multivariate analysis also revealed significant relationships between SI and AKI (P<0.001), postoperative ICU admission (P<0.005) and ICU LOS (P<0.001). SI does not significantly affect 2-year mortality. Conclusion: SI is useful in predicting postopera-tive mortality at 1 month, 3 months, AKI, postoperative ICU admission and ICU LOS.
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来源期刊
Annals Academy of Medicine Singapore
Annals Academy of Medicine Singapore 医学-医学:内科
CiteScore
4.90
自引率
5.80%
发文量
186
审稿时长
6-12 weeks
期刊介绍: The Annals is the official journal of the Academy of Medicine, Singapore. Established in 1972, Annals is the leading medical journal in Singapore which aims to publish novel findings from clinical research as well as medical practices that can benefit the medical community.
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