2025 年第 6 期 第 20 卷

三尖瓣反流与非心脏术后患者重症监护病房住院时间延长的相关性分析及列线图构建

Correlation analysis of tricuspid regurgitation and prolongation of intensive care unit length of stay in patients after non-cardiac surgery and nomogram construction

作者：王静怡1刘一凡2李文雄1张进1

英文作者：Wang Jingyi1 Liu Yifan2 Li Wenxiong1 Zhang Jin1

单位：1首都医科大学附属北京朝阳医院重症医学科，北京100020；2首都医科大学附属北京朝阳医院心脏中心，北京100020

英文单位：1Department of Intensive Care Unit Beijing Chao-Yang Hospital Capital Medical university Beijing 100020 China; 2Heart Center Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

关键词：三尖瓣反流；重症监护病房住院时间；预测模型

英文关键词：Tricuspidregurgitation;Intensivecareunitlengthofstay;Predictionmodel

• 摘要：

• 目的 探讨三尖瓣反流与非心脏术后重症患者重症监护病房住院时间（ICU-LOS）延长的相关性，并构建ICU-LOS延长列线图预测模型。方法 选取2019年1月至2021年12月首都医科大学附属北京朝阳医院非心脏术后立即转入ICU的重症患者，收集患者的基线资料、术前超声心动图、术前化验指标、手术时长、术中出血量以及入ICU时急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分，主要研究终点是ICU-LOS延长（＞72 h）发生率。采用Cox回归分析三尖瓣反流与ICU-LOS延长的关系以及影响ICU-LOS延长的临床危险因素，并基于三尖瓣反流联合其他临床危险因素构建列线图预测模型。结果 本研究纳入非心脏术后立即收入ICU的成年患者共2 416例，606例（25.1%）术前合并三尖瓣反流，其中轻度及以下反流患者536例（88.4%），中度及以上反流患者70例（11.6%）。多因素Cox回归分析结果显示，年龄、节段性室壁运动异常、三尖瓣反流、手术时长、术中出血量和APACHE Ⅱ评分是非心脏术后重症患者ICU-LOS延长的独立危险因素（均P＜0.05）。基于上述危险因素构建预测ICU-LOS延长列线图，受试者工作特征曲线下面积为0.822（95%置信区间：0.799～0.844，P＜0.001）。结论 三尖瓣反流是非心脏术后重症患者ICU-LOS延长的独立危险因素，基于三尖瓣反流联合其他临床指标（年龄、节段性室壁运动异常、手术时长、术中出血量以及APACHE Ⅱ评分）构建的列线图模型对非心脏术后重症患者ICU-LOS延长具有良好的预测能力。

• Objective To explore the correlation between tricuspid regurgitation and the prolongation of the intensive care unit length of stay (ICU-LOS) in critically ill patients after non-cardiac surgery, and to construct the nomogram predictive model of ICU-LOS prolongation. Methods Critically ill patients who were transferred to ICU immediately after non-cardiac surgery in Beijing Chao-yang Hospital, Capital Medical University from January 2019 to December 2021 were selected. The patients′ baseline data, preoperative echocardiography, preoperative laboratory indicators, operation duration, intraoperative blood loss, and acute physiology and chronic health score system Ⅱ (APACHE Ⅱ) score at ICU admission were collected. The primary endpoint was the incidence of prolonged ICU-LOS (>72 h). Cox regression was used to analyze the relationship between tricuspid regurgitation and ICU-LOS prolongation and the clinical risk factors affecting ICU-LOS prolongation, and a nomogram prediction model was constructed based on tricuspid regurgitation combined with other clinical risk factors. Results A total of 2 416 adult patients admitted to ICU immediately after non-cardiac surgery were included in this study. Six hundred and six patients (25.1%) were complicated with tricuspid regurgitation before surgery, including 536 patients (88.4%) with mild or less regurgitation and 70 patients (11.6%) with moderate or more regurgitation. Multivariate Cox regression analysis showed that age, segmental wall motion abnormalities, tricuspid regurgitation, operation time, intraoperative blood loss and APACHE Ⅱ score were independent risk factors for prolonged ICU-LOS in critically ill patients after non-cardiac surgery (all P<0.05). A nomogram for predicting ICU-LOS prolongation was constructed based on the above risk factors, and the area under the receiver operating characteristic curve was 0.822 (95% confidence interval: 0.799-0.844, P<0.001). Conclusion Tricuspid regurgitation is an independent risk factor for ICU-LOS prolongation in critically ill patients after non-cardiac surgery. The nomogram model based on tricuspid regurgitation combined with other clinical indicators (age, segmental wall motion abnormalities, operation duration, intraoperative blood loss, and APACHE Ⅱ score) has good predictive ability for ICU-LOS prolongation in critically ill patients after non-cardiac surgery.