糖尿病患者非心脏手术围术期心血管事件的危险因素  

Risk factors for perioperative cardiovascular events in patients with diabetes mellitus undergoing noncardiac surgery

作　　者：吴国荣[1] 郑晋伟[1] 陈骏萍[1] 甘林光[1] 胡序凯[1] 张晓艳[1] 

机构地区：[1]宁波市第二医院麻醉科,315010

出　　处：《中华麻醉学杂志》2013年第6期665-668,共4页Chinese Journal of Anesthesiology

基　　金：浙江省宁波市科技局课题（2011C50056）

摘　　要：目的筛选糖尿病患者发生围术期心血管事件（PCE）的危险因素。方法择期行非心脏手术的糖尿病患者500例，根据围术期是否发生PCE分为PCE组和非PCE组。记录患者一般资料和麻醉方式、麻醉时间、术中血糖、血流动力学波动情况。将组间差异有统计学意义的因素进行logistic回归分析，筛选PCE的危险因素。结果79例患者发生PCE，发生率为15．8％。2组患者年龄、甘油三酯水平、高敏C反应蛋白（hs—CRP）水平、血流动力学波动情况、ECG异常比率比较差异有统计学意义（P〈0．05）。logistic回归分析结果显示，甘油三酯≥1．7mmol／L、年龄≥65岁、hs-CRP≥8mg／L和术中血流动力学异常波动≥基础值30％是非心脏手术糖尿病患者PCE的危险因素。结论高甘油三酯、老龄、高hs-CRP水平和术中血流动力学异常波动（≥基础值30％）是糖尿病患者非心脏手术围术期PCE的危险因素。Objective To determine the risk factors for perioperative cardiovascular events （PCEs） in pa- tients with diabetes mellitus undergoing noncardiac surgery. Methods From June 2011 to October 2012 in our hos- pital, 500 diabetic patients scheduled for elective non-cardiac surgery were divided into 2 groups according to the development of PCEs： PCE group and non-PCE group. The general data of patients, anesthetic methods, anesthe- sia time, blood glucose level during surgery and fluctuation of hemodynamics were recorded. The risk factors of which P values were less than 0.05 would enter the binary logistic regression analysis to stratify PCE-related risk factors. Results Seventy-nine patients developed PCEs （15.8 % ） during perioperative period. There was significant difference between the two groups in age, levels of triglyceride and hs-CRP, fluctuation of hemodynamics, and abnormality in ECG （P 〈 0.05）. Logistic regression analysis showed that the risk factors for PCEs included trig- lyceride level ≥ 1.7 mmol/L, age t〉 65yr, hs-CRP level ≥ 8 mg/L and fluctuation of hemodynamics during surgery ≥ 30 % of the baseline value. Conclusion High triglyceride levels, advanced age, high hs-CRP levels and fluctuation of hemodynamies during surgery （≥ 30% of the baseline value） are the risk factors for PCE in diabetic patients undergoing noncardiae surgery.

关 键 词：糖尿病 手术中并发症 心血管疾病 危险因素 

分 类 号：R614[医药卫生—麻醉学]