50岁以上腹主动脉瘤切除术后心脏损伤预测因素分析  

A retrospective analysis of predictive factors associated with myocardial injury following open surgery for abdominal aortic aneurysm in patients>50 years of age

作　　者：耿丽敏[1,2] 张京岚[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所综合外科ICU,北京100029

出　　处：《心肺血管病杂志》2012年第5期542-544,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：2012年首都医科大学基础临床课题(项目编号12JL58)

摘　　要：目的:研究腹主动脉瘤切除术后心脏损伤的预测因素。方法:收集72例50岁以上行腹主动脉瘤手术患者临床资料,测定术前及术后24 h肌钙蛋白I(cTnI)浓度,分为cTnI升高组与正常组,比较2组的临床资料,采用χ2检验与Logistic回归分析确定心脏损伤的预测因素。结果:72例行腹主动脉瘤切除术的患者,术后CTnI升高者30例,发生率为41.7%。术前心电图示ST-T改变及冠状动脉CT造影(CTA)显示,1枝以上血管狭窄(≥50%)在cTnI升高组及正常组之间差异有统计学意义(P<0.05),并经Logistic回归分析证实,心电图ST-T改变OR值为2.807(95%CI=1.065～7.398,P=0.037),冠状动脉CTA示1枝以上狭窄OR值为11.579(95%CI=2.332～57.497,P=0.003)。结论:术前心电图ST-T改变及冠状动脉CTA示1枝以上狭窄(≥50%)为腹主动脉瘤切除术后心脏损伤的预测因素。Objective： To investigate the predictive factors associated with myocardial injury following open surgery for abdominal aortic aneurysm. Methods：The clinical data of 72 patients who underwent open sur- gery for abdominal aortic aneurysm were studied with the eoncerntration of cardiac troponin I （cTnI） being measured preoperatively on the fore-and-aft operation. By comparing the clinical characteristics of the patients with elevated cTnI and normal cTnI, the predictive factors were obtained by X2 test and Logistic analysis. Re- suits： Postoperatively, elevated cTnI was found in 30 of the 72 patients （41.7%）. The predictive factors for cTnI elevation appeared associated with ECG change of ST-T and Coronary CTA displaying at least one stenosis （ ≥50% ）, which were different in statistics （ P 〈 0. 05 ）. Patients with elevated eTnI had an increased odds ratio for ECG change of ST-T （ OR = 2. 807 [ 95% CI, 1. 065 to 7. 398 ] ,P = 0. 037 ） and Coronary CTA （ OR = 11. 579 [ 95 % CI,2. 332 to 57. 497 ] , P = 0. 003 ）. Conclusion ： ECG change of ST-T and Coronary CTA dis- playing at least one stenosis （ ≥50% ）were the predictive factors of myocardial injury following open surgery for abdominal aortic aneurysm.

关 键 词：腹主动脉瘤切除术 心脏损伤 预测因素分析 

分 类 号：R54[医药卫生—心血管疾病]