非心血管手术围术期心肌缺血危险因素的临床研究  

Clinic study on risk factors of perioperative myocardial ischemia after noncardiovascular surgery

作　　者：杨京利 马国平 

机构地区：[1]上海市浦东医院麻醉科,201399 [2]上海市浦东新区周浦医院麻醉科

出　　处：《中华临床医师杂志（电子版）》2014年第15期10-13,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的通过对冠心病患者或有冠心病危险因素患者术后心肌缺血和心血管事件的临床研究,探讨围术期心肌缺血的危险因素。方法参照美国心脏病学会/美国心脏协会(ACC/AHA)的"围手术期心血管风险"预测标准共入选病例98例。患者入手术室后行Holter监测,持续至术后48 h,术后患者入住SICU病房,监测相关指标:血流动力学监测、血气分析、电解质、应激水平(血皮质醇、血糖、白细胞介素-6)、肌钙蛋白I、体温监测、疼痛评分,术后随访至患者出院。根据Holter监测分析结果将患者分为术后心肌缺血组和非缺血组,两组间各监测指标先行单因素分析,有意义的指标再行Logistic回归分析。结果缺血组和非缺血组间心血管事件发生差异有统计学意义(P<0.05),缺血组心动过速、低血压、低体温、低氧血症高于非缺血组(P<0.05);经多因素Logistic回归分析,心动过速、低血压、低体温、低氧血症是围术期心肌缺血的危险因素(P<0.05)。结论术后心肌缺血是术后心血管事件的预警指标,心动过速、低血压、低体温、低氧血症是术后心肌缺血的危险因素。Objective Analyzing postoperative myocardial ischemia and cardiovascular events in patients with coronary heart disease or risk factors of coronary heart disease, to search the predisposing cause of postoperative myocardial ischemia and meaningful monitoring marks. Methods According to the “ACC/AHA Guideline for Perioperative Cardiovascular Evaluation for Noncardiac Surgery”, ninety-eight patients were collected after preoperative interview. Patients were monitored with Holter system as they were carried into operation rooms. After surgery, patients were monitored and treated aggressively in SICU. Monitoring marks included bloodstream dynamics, blood gas analysis, electrolyte, stress level（corticosteroids, blood glucose, IL-6）, cardiac troponin I, temperature, pain score. Holter monitoring lasted 48 hours during postoperative period. Patients were followed in hospital. According to the results of the Holter monitoring, patients were classified into postoperative ischemic group and non-ischemic group. Results were compared using t or χ2 statistic between two groups. Logistic regression were attempted in multivariate analysis. Results The rate of cardiovascular events in ischemic group was significantly higher than that in non-ischemic group（P〈0.05）. The rates of tachycardia, hypotension, hypothermia and hypoxemia in ischemic group were significantly higher than that in non-ischemic group, showing a positive correlation（P〈0.05）. Conclusions Postoperative myocardial ischemia is the alarming mark of postoperative cardiovascular events. Tachycardia, hypotension, hypothermia and hypoxemia are the risk factors of postoperative myocardial ischemia.

关 键 词：心肌缺血 非心血管手术 心血管事件 

分 类 号：R619[医药卫生—外科学]