心血管危险评估指数对腹腔内手术围手术期心血管风险的适用性分析  

Evaluation of application of Revised Cardiac Risk Index on analysis of incidence of perioperative cardiovascular events

作　　者：李佩雯[1] 韩晓宁[2] 张静梅[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心脏科,江苏210008 [2]北京大学第一医院心内科

出　　处：《交通医学》2013年第3期256-259,共4页Medical Journal of Communications

摘　　要：目的：调查腹腔内手术围手术期心血管事件发生率,分析心血管危险评估指标（RCRI）评估腹腔内手术围手术期心血管风险的适用性。方法：腹腔内手术患者1079例分别用美国麻醉医师协会（ASA）体格情况分级、Gold-man指数及RCRI进行分级,统计各级心血管事件发生率及全因死亡率并进行比较分析。结果：（1）围手术期心血管事件发生率：主要心血管事件43例（3.99%）,心血管事件74例（6.86%）,全因死亡17例（1.58%）。（2）主要心血管事件发生率：①ASA体格情况分级Ⅰ-Ⅳ级相对应的主要心血管事件发生率为0%、2.28%、12.58%、42.86%。②Goldman指数Ⅰ-Ⅲ级相对应的主要心血管事件发生率为1.11%、6.42%、10.53%。③RCRIⅡ-Ⅳ级相对应的主要心血管事件发生率为2.36%、8.61%、23.08%。（3）预测事件的ROC曲线下面积：①ASA体格情况分级为0.73-0.76;②Goldman指数为0.66-0.70;③RCRI指数为0.63-0.68,三者比较差异无统计学意义（P〉0.05）。结论：RCRI可以客观、简便地评估腹腔内手术围手术期心血管风险,其预测准确性与ASA体格情况分级及Goldman指数相当。Objective： The study was designed to investigate incidence of perioperative cardiovascular events and evaluate the applicability of RCRI（Revised Cardiac Risk Index）,for the patients undergoing intraperitoneal surgery.Method： 1079 patients who underwent intraperitoneal surgery（exclude laparoscope surgery） were classified by ASA physical status,Goldman’s index and RCRI;Incidence of cardiovascular events and all-cause mortality of different class were analysed and compared.Result： For the patients undergoing intraperitoneal surgery,the incidence of major cardiovascular events was 3.99%,the incidence of cardiovascular events was 6.86%,all-cause mortality was 1.58%.The incidence of major cardiovascular events with ASA physical statusⅠ-Ⅳ were 0%,2.28%,12.58% and 42.86%;and with Goldman index ClassⅠ- Ⅲ were 1.11%,6.42% and 10.53%;and with RCRI ClassⅡ-Ⅳ were 2.36%,8.61% and 23.08%.As to evaluate the predictability of cardiac events,the area under ROC curve of these three indexes were 0.73-0.76,0.66-0.70 and 0.63-0.68,with no statistical difference.Conclusion： Revised Cardiac Risk Index could be objective and easy to assess perioperative cardiovascular risk of intraperitoneal surgery,with similar prediction accuracy to ASA physical status or Goldman’s index.

关 键 词：心血管事件 腹腔内手术 围手术期 美国麻醉医师协会体格情况分级 Goldman指数 心血管危险评估指数 

分 类 号：R619[医药卫生—外科学]