老年非心脏手术患者围术期心血管事件危险因素的分析  

The analysis for the risk factors of cardiovascular events during perioperative period in the elderly patients undergoing non-cardiac surgery

作　　者：张佩军[1] 思永玉[2] 黄青青[2] 张自云[2] 岳锦熙[2] 

机构地区：[1]天津市中心妇产科医院,300100 [2]昆明医学院第二附属医院麻醉科

出　　处：《河北医药》2011年第7期975-977,共3页Hebei Medical Journal

摘　　要：目的探讨老年非心脏手术患者围术期心血管事件发生的相关危险因素。方法 2007年3月至2008年3月,收集昆明医学院第二附属医院年龄≥70岁的择期非心脏手术患者282例。记录每例患者术前的一般资料,从手术开始到术后连续48hHolter监测,记录术中情况及术后心血管事件发生情况。运用多因素Logistic回归,分析入选患者住院期间心血管事件的发生情况,得出非心脏手术老年患者围术期心血管事件的相关危险因素。结果 63例患者住院期间发生心血管事件,总发生率为22.3%;其中各类心血管事件发生率分别为,心肌缺血13.1%、房颤6%、Lown氏分级Ⅳ级以上的室性早搏4.3%、心绞痛1.1%、心肌梗死(心源性死亡)0.4%;围术期心血管事件相关的5个危险因素分别为:糖尿病[OR值2.348,95%可信区间为(1.128,4.887),P=0.022]、冠心病[OR值2.848,95%可信区间为(1.147,7.070),P=0.024]、术前ST缺血改变[OR值2.803,95%可信区间为(1.057,7.430,P=0.038]、术中失血量≥1500ml[OR值4.389,95%可信区间为(1.288,14.961),P=0.018]、术中血流动力学改变[OR值3.062,95%可信区间为(1.244,7.539),P=0.015]。结论围术期心血管事件中,心肌缺血的发生率最高,且多为无症状性心肌缺血(silent myocardial ischemia,SMI);糖尿病、冠心病、术前ST缺血改变、术中失血量≥1500ml、术中血流动力学改变5个因素为老年患者围术期心血管事件发生的独立危险因素。Objective To investigate the incidence of cardiovascular events during perioperative period and its related risk factors in elderly patients undergoing non-cardiac surgery.Methods From March,2007 to March,2008,282 patients whose age was under 70 year were enrolled in the study,and these patients underwent non-cardiac surgery in the Second Hospital of Kunming Medical College.The patients’general information was recorded,at the same time,dynamic electrocardiogram was performed continuously with 24 hour Holter to record the incidence of cardiovascular events from the beginning of operation to 48 hours after operation.Then vital signs were recorded 24h and 48h after the operation,and the incidence of cardiovascular events was observed.The incidence of cardiovascular events during perioperative period and its related risk factors were analyzed by using the method of Multi-factor Logistic Regression Analysis.Results 63 patients were suffered from cardiovascular events in hospitalization,and the total morbidity rate was 22.3%,in which the myocardial ischemia accounted for 13.1%,atrial fibrillation 6%,more than Ⅳ ventricular premature beat （VPB） according to Lown’s grade levels 4.3%,angina pectoris 1.1% and myocardial infarction （cardiac death） 0.4%.The five correlated risk factors of preoperative cardiovascular events in turn were diabetes mellitus （odds ratio 2.348,95% confidence interval[1.128,4.887],P0.05）,coronary heart disease （odds ratio 2.848,95% confidence interval [1.147,7.070],P0.05）,preoperative ST ischemic changes （odds ratio 2.803,95% confidence interval[1.057,7.430],P0.05）,blood loss more than 1,500ml （odds ratio 4.389,95% confidence interval [1.288,14.961],P0.05） and hemodynamics changes during operation （odds ratio 3.062,95% confidence interval [1.244,7.539],P0.05）.Conclusion The incidence of perioperative cardiovascular events is the highest in myocardial ischemia,which accounted for 59% of all the cases,and the most of which are silent myocardial ischemia（SMI）.The

关 键 词：老年 围手术期 非心脏手术 心血管事件 

分 类 号：R619[医药卫生—外科学]