高龄冠心病患者行非心脏手术的围术期心脏事件危险因素分析  

Risk Factors of Perioperative Cardiac Events in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery

作　　者：刘子嘉[1] 许力[1] 于春华[1] 郑宏[2] 姚尚龙[3] 裴凌[4] 孙莉[5] 姜晶梅[6] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730 [2]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054 [3]华中科技大学同济医学院协和医院麻醉科,武汉430022 [4]中国医科大学第一附属医院麻醉科,沈阳110001 [5]中国医学科学院北京协和医学院肿瘤医院麻醉科,北京100021 [6]中国医学科学院北京协和医学院基础医学研究所统计与流行病学教研室,北京100005

出　　处：《中国医学科学院学报》2015年第5期541-548,共8页Acta Academiae Medicinae Sinicae

基　　金：卫生部公益性行业科研专项(200802030)~~

摘　　要：目的探讨行非心脏手术的高龄冠心病患者围术期心脏事件的发生率及危险因素。方法采取多中心前瞻性队列研究,入选2008年1月至2010年1月,5家中心年龄≥75岁择期行中危或高危非心脏手术的冠心病患者360例,以统一的病例报告表对术前、术中及术后临床资料进行记录,包括术后即刻及3 d的12导联心电图及血肌钙蛋白I水平。以围术期主要心脏事件为终点。采用单因素分析和多因素Logistic回归分析,寻找该人群围术期心脏事件的危险因素并进行危险分层。结果高龄冠心病患者行非心脏手术围术期主要心脏事件的发生率为11.94%。该人群围术期主要心脏事件的独立危险因素包括半年内心绞痛史(P=0.001)、高血压史(P=0.014)、红细胞压积<40%(P=0.050)、血肌酐>150 mmol/L(P=0.014)、射血分数<50%(P=0.019)、术中低氧(P=0.019)及手术时间>150 min(P=0.001),其危险指数分别为4、3、3、6、4、5、4。依据危险指数评分进行危险分层,随分层级数增加围术期心脏事件的发生率显著增加。结论高龄冠心病患者行非心脏手术围术期心脏事件高发。半年内心绞痛史、高血压史、红细胞压积<40%、血肌酐>150 mmol/L、射血分数<50%、术中低氧、以及手术时间>150 min均增加该人群围术期心脏风险。根据其危险指数进行危险评分及分层可较好地评估高龄冠心病患者的围术期心脏风险。Objective To identify the incidence and risk factors of perioperative major adverse cardiac events（ MACE） in elderly patients with coronary heart disease（ CHD） undergoing non-cardiac surgery. Methods We prospectively analyzed the clinical data of 360 CHD patients who aged 75 years or older undergoing elective intermediate-to high-risk surgery in five medical centers across China from January 2008 to January 2010.The clinical variables included the 12-lead ECG and Troponin I levels after surgery. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and their indexes were analyzed with univariate analysis and multivariable logistic regression in SPSS software,together with a risk scoring and stratification system established. Results Perioperative MACE occurred in 11. 94% of elderly CHD patients undergoing non-cardiac surgery. Seven independent risk factors of perioperative MACE for this population were identified,which included angina within 6 months（ P = 0. 001）, hypertension（ P = 0. 014）, preoperative haematocrit（ HCT） 〈40%（ P = 0. 050）,serum creatinine（ Scr）〉 150 mmol / L（ P = 0. 014）,ejection fraction（ EF） 50%（ P = 0. 019）,intraoperative hyoxemia（ P = 0. 019）,and operative time 〉150 min（ P =0. 001）. The risk indexes of these factors were 4,3,3,6,4,5,and 4,respectively. The rate of perioperative MACE increased significantly as the level of risk stratification elevated. Conclusions Elderly CHD patients undergoing non-cardiac surgery are at high risk of perioperative MACE. Angina within 6 months,hypertension,preoperative HCT 〈40%,Scr 〉150 mmol / L,EF 〈50%,intraoperative hyoxemia,and operative time 〉150 min can increase the risk of MACE. The risk scoring and stratification system based on the risk factor index can be a valuable parameter for assessing the perioperative cardiac risk of noncardiac surgery for elderly CHD patients.

关 键 词：高龄 冠心病 非心脏手术 心脏事件 危险因素 

分 类 号：R614.2[医药卫生—麻醉学]