应用广义估计方程对老年冠心病患者非心脏手术术中高血压发生风险的评价  

An Application of Generalized Estimating Equations Inevaluating the Risk of Observed Hypertension in Non-institute Cardiac Surgical Procedures for Elderly Patients with CHD

作　　者：韩伟[1,2] 薛芳[1,2] 姜晶梅[1,2] 

机构地区：[1]中国医学科学院基础医学研究所 [2]北京协和医学院基础学院流行病与统计学系

出　　处：《中国卫生统计》2011年第6期613-616,共4页Chinese Journal of Health Statistics

摘　　要：目的运用广义估计方程对不同麻醉方式下(吸入麻醉和静脉维持麻醉)老年冠心病患者非心脏手术术中高血压发生的风险进行评价。方法数据来自临床多中心试验。在4家三级甲等医院按纳入标准及排除标准选取择期进行非心脏手术的60岁以上老年冠心病患者,将患者按照不同麻醉方式随机分为吸入麻醉组和静脉麻醉组,观察两组患者术中高血压发生情况,并在控制其他混杂因素后,评价采用不同麻醉方式的老年冠心病患者术中发生高血压的风险是否不同。分析过程采用广义估计方程,并采用QIC准则以及累积残差对模型进行评价。结果在控制了性别、年龄、术中降压药物的使用,并且考虑了麻醉过程中病人各个时点高血压发生的相关性后,吸入组患者术中各个测量时点的高血压的发生率明显低于静脉组患者(P<0.05)。结论吸入麻醉在应用于老年冠心病患者非心脏手术时可以降低术中高血压发生的风险,广义估计方程在处理分类纵向资料测量值之间的相关性上有其独到的优势,可减小信息的损失。Objective Using generalized estimating equations（GEE） to evaluate the risk of hypertension of patients with coronary heart disease in non-cardiac surgery by different anesthesia（inhalation anesthesia and intravenous anesthesia maintenance）.Methods Data were collected from clinical multi-center trial.Patients with coronary heart disease over 60 years old undergoing non-cardiac surgery were selected by inclusion criteria and exclusion criteria in four Grade Ⅲ Class A hospitals.The patients were randomly divided into inhalation anesthesia group and intravenous anesthesia group and were observed in the incidence of hypertension.The difference of the risk of hypertension between the two group is evaluated after controlling of other confounding factors.GEE was used in the analytic process.Quasi-likelihood under the independence model criterion （QIC） and Cumulative residuals were employed to select and evaluate the models.Results The risk of hypertension in inhalation anesthesia group were significantly lower than intravenous anesthesia group（P0.05） after controlling the sex,age,intraoperative antihypertensive drugs.Conclusion Inhalation anesthesia in elderly patients with coronary heart disease in non-cardiac surgery can reduce the risk of intraoperative hypertension.GEE has its unique advantages in analyzing the categorical longitudinal data,and its application can greatly reduce the loss of informations.

关 键 词：广义估计方程 QIC准则 累积残差 麻醉方式 术中高血压 

分 类 号：R614[医药卫生—麻醉学]