踝-臂血压指数预测非心脏手术后发生心脏并发症的风险  

作　　者：Bruce W. Fisher Gillian Ramsay Sumit R. Majumdar Chantelle T. Hrazdil Barry A. Finegan Rajdeep S. Padwal Finlay A. McMister 姚刚(译) 喻田(校) 

机构地区：[1]Division of General Internal Medicine,University of Alberta, Edmonton, Canada [2]Department of Anaesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada [3]不详

出　　处：《麻醉与镇痛》2009年第4期52-58,共7页Anesthesia & Analgesia

摘　　要：背景已经证实踝．臂血压指数（AAI）减小有助于诊断外周动脉阻塞性疾病（PAD）进而预测心血管事件的发生。然而，AAI与非心脏手术患者手术后心血管系统并发症之间的关系尚未见有报道。方法我们前瞻性地连续研究了242例50岁及以上拟行择期非心脏手术的大学医院门诊患者。我们通过触诊及多普勒超声技术测定患者的校正心脏危险指数（rCRI）和AAI。有一名不了解患者手术前评估及AAI结果的独立观察者对手术后前7天的心脏并发症进行确证。AAI≤0．9或触摸不到4条动脉脉搏搏动定义为AAI异常。异常的AAI用于预测手术后心血管系统并发症的发生，同时用似然比（LR）、ROC曲线下面积（AUC）以及多元逻辑回归来校正rCRI。结果受试者的平均年龄为67岁，60％为男性，19％患有糖尿病，14％患有缺血性心脏病以及35％的患者接受开腹或者开胸手术。手术后，242例中有14例（6％）患者发生心脏并发症，但无死亡病例。44例患者出现了异常的AAI，其中10例（23％）手术后发生心脏并发症：阳性LR4．79（95％可信区间：3．04—7．54），阴性LR0．34（95％可信区间：0．15—0．77），AUC：0．80。AAI与rCRj相比更具有说服力，rCRI阳性LR为4．22（95％可信区间：2．24—7．95），阴性LR为0．57（95％可信区间：0．34。0．96）和AUC=0．74。多因素变量分析，经过rCRI结果校正后，AAI异常的患者发生心脏并发症的校正优势比为10．16（95％可信区间：2．90—36．02）。结论AAI异常地低下是潜在外周动脉阻塞性疾病的诊断指标，同时还是非心脏手术后发生心脏并发症的独立危险因素，并且其准确度和rCRI相似，而且AAI还可以为手术前心脏危险性评估分级提供依据。BACKGROUND： Peripheral arterial disease, as detected by a reduced ankle-to-arm blood pressure index （AAI）, has been shown to predict future cardiac events. However, the utility of measuring the AAI to predict postoperative cardiac complications in patients undergoing noncardiac surgery is unloaown. METHODS： We pro- spectively studied 242 consecutive patients aged 50 yr or older presenting to a university hospital preadmission clinic before elective noncardiac surgery. We performed a standardized clinical evaluation that included calculation of the revised cardiac risk index （rCRI） and measurement of the AAI using both palpation and Doppler techniques. Independent observers, blinded to preoperative assessment and AAI results, ascertained cardiac complications in the first 7 days after surgery. We assessed the ability of an abnormal AAI ≤0.9 or absence of all four pedal pulses） to predict postoperative cardiac complications using likelihood ratios （LR）, area under the ROC curves （AUC）, and multivariable logistic regression in which we adiusted for the rCRI result. RESULTS： The cohort had a median age of 67 yr, 60% were male, 19% had diabetes, 14% had ischemic heart disease, and 35% underwent intraperitoneal or intrathoracic surgery. Postoperatively, 14 of 242 （6%） patients suffered cardiac complications, but no patients died. An abnormal AAI was present in 44 patients, 10 （23%） of whom had postoperative cardiac complications： positive LR 4.79 （95% CI： 3.04 -7.54）, negative LR 0.34 （95% CI： 0. 15 -0.77）, AUC = 0. 80. The AAI compared favorably with the rCRI, which had positive LR4.22 （95% CI： 2.24 -7.95）, negative LR0.57 （95% CI： 0. 34 -0. 96）, and AUC = 0.74. In multivariate analysis, the adiusted odds ratio for having a cardiac complication was 10. 16 （95% CI： 2.90 -36. 02） for those patients with an abnormal AAI, even after adiusting for rCRI results. CONCLU- SIONS： An abnormally low AAI, indicative of underlying peripheral arterial disease, is a

关 键 词：心脏并发症 踝-臂血压指数 预测 非心脏手术后 

分 类 号：R541[医药卫生—心血管疾病]