修订的心脏风险指数对老年冠心病患者非心脏手术围手术期主要心脏不良事件的临床评估价值  

Clinical Utility of Revised Cardiac Risk Index to Predict Perioperative Cardiac Events in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery

作　　者：刘乐义 刘子嘉[2] 许广艳 张凤岩 许力[2] 黄宇光[2] LIU Leyi;LIU Zijia;XU Guangyan;ZHANG Fengyan;XU Li;HUANG Yuguang(Department of Anesthesiology,Wuhu Traditional Chinese Hospital,Wuhu,Anhui 241000,China;Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Anesthesiology,Quyang People’s Hospital,Quyang,Hebei 073100,China)

机构地区：[1]芜湖市中医医院麻醉科,安徽芜湖241000 [2]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 [3]河北省曲阳县人民医院麻醉科,河北曲阳073100

出　　处：《中国医学科学院学报》2020年第6期732-739,共8页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨修订的心脏风险指数(RCRI)在老年冠心病患者非心脏手术中的评估价值。方法回顾2013年1月至2019年9月年龄≥65岁择期行中危或高危非心脏手术的冠心病患者2100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,并计算患者RCRI和改进的RCRI(R-RCRI)评分,以围手术期主要心脏不良事件(MACE)为终点,采用多因素Logistic回归分析该人群围手术期MACE的危险因素,以受试者工作特征曲线下面积比较RCRI指数、R-RCRI指数以及本研究独立危险因素指数评分对围手术期MACE的预测价值。结果老年冠心病患者行非心脏手术围手术期MACE的发生率为5.4%。该人群围手术期MACE的独立危险因素包括:年龄≥80岁;女性;心衰史;胰岛素控制的糖尿病;术前ST段异常;美国麻醉医师协会分级≥Ⅲ,其危险指数分别为2、2、2、2、2、3。RCRI指数、R-RCRI指数以及本研究独立危险因素指数的受试者工作特征曲线下面积分别为0.586、0.552和0.741。结论RCRI评分与老年冠心病非心脏手术患者的围手术期MACE相关性较差,对于该人群应选择更优的心脏风险评估方法。Objective To explore the predictive ability of the revised cardiac risk index(RCRI)in elderly patients with coronary heart disease(CHD)undergoing non-cardiac surgery.Methods We performed a retrospective study including a total of 2100 patients,aged ≥65 with a history of CHD who underwent non-cardiac surgery form January 2013 to September 2019.The preoperative,intraoperative and postoperative clinical data were extracted from an electronic database.The RCRI and reconstructed-RCRI(R-RCRI)score of each patient were calculated.The primary end point was defined as an occurrence of perioperative MACE.Multivariate logistic regression analysis was performed to evaluate the risk factors of perioperative MACE.The area under the receiver operating characteristic(ROC)curve was used to compare the predictive value of RCRI,R-RCRI,and the new risk scoring system of the study for perioperative MACE.Results The incidence of perioperative MACE in elderly patients with CHD was 5.4%.Six independent risk factors of perioperative MACE for this population were identified:age ≥80 years;female;history of heart failure;insulin-depended diabetes mellitus;preoperative ST segment abnormality;American Society of Anesthesiologists grade ≥Ⅲ,and the risk index was 2,2,2,2,2 and 3 respectively.The area under ROC curve of RCRI,R-RCRI and risk scoring system in this study were 0.586,0.552 and 0.741.Conclusion The correlation between RCRI score and perioperative MACE was poor in elderly patients with CHD undergoing non-cardiac surgery,and a better cardiac risk assessment method should be established for this population.

关 键 词：老年 冠心病 非心脏手术 心脏风险指数 心脏事件 

分 类 号：R619[医药卫生—外科学]