择期颈椎手术患者围术期发生主要不良心脏事件的影响因素  

Analysis of major adverse cardiac events and risk factors during perioperative period of cervical spine surgery

作　　者：张鑫[1] 王慧[1] 刘肃[1] 马朋朋[1] 蔡明 张春玲[1] 张振帮 Xin Zhang;Hui Wang;Su Liu;Pengpeng Ma;Ming Cai;Chunling Zhang;Zhenbang Zhang(Department of Orthopaedic Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Outpatient,Chengde Shuangqiao Maternal and Child Health Hospital,Chengde 067022,China)

机构地区：[1]河北北方学院附属第一医院骨外科,张家口075000 [2]河北省承德市双桥区妇幼保健院门诊科,承德067022

出　　处：《中国综合临床》2023年第4期276-280,共5页Clinical Medicine of China

基　　金：河北省医学科学研究课题计划项目(20220612);张家口市重点研发计划项目(2021107D)。

摘　　要：目的探讨择期颈椎手术患者围术期发生主要不良心脏事件(major adverse cardiac events,MACE)的影响因素。方法回顾性分析河北北方学院附属第一医院2017年3月至2021年3月收治的426例行择期颈椎手术患者的临床资料。收集患者的基本信息,包括性别、年龄、体质量指数(body mass index,BMI)、基础疾病,并根据基础疾病计算Charlson合并症指数(Charlson comorbidity index,CCI),收集术前血清肌钙蛋白I(cardiac troponin I,cTnI)水平和围术期MACE发生情况以及手术相关指标,包括颈椎手术类型、手术方式、入路方式、手术时间、麻醉时间、术中出血量、术后疼痛视觉模拟量表(visual analogue scale,VAS)评分、电解质紊乱情况。计数资料以例(%)表示,组间比较采用χ^(2)检验;应用Logistic回归模型对颈椎手术患者围术期发生MACE的影响因素进行多因素分析。结果426例患者中围术期发生MACE 54例(12.68%),其中不稳定型心绞痛4例(7.41%)、急性心肌梗死4例(7.41%)、严重心律失常33例(61.11%)、急性心力衰竭13例(24.07%)。多因素Logistic回归分析结果显示,年龄增加(50~59岁:比值比=1.34,95%置信区间:1.14~1.78;60~69岁:比值比=1.48,95%置信区间:1.20~1.86;70~79岁:比值比=1.71,95%置信区间:1.34~2.57;80~89岁:比值比=1.95,95%置信区间:1.46~2.85)以及女性、CCI评分>3分、术前cTnI>0.04μg/L、术后VAS评分>5分和电解质紊乱均为颈椎手术患者围术期发生MACE的影响因素(比值比分别为1.84、2.12、2.34、2.57、2.20,95%置信区间分别为1.34~2.68、1.50~3.41、1.63~3.72、1.53~4.01、1.43~3.69,均P<0.05)。结论择期颈椎手术患者围术期MACE的发生率较高,年龄增加、女性、高CCI评分、术前血清cTnI水平较高、术后疼痛和电解质紊乱均为择期颈椎手术患者围术期MACE发生的影响因素。Objective To understand the occurrence of major adverse cardiac events(MACE)during the perioperative period of cervical spine surgery and analyze its risk factors.Methods A retrospective analysis of 426 cervical spine surgery patients admitted to the from March 2017 to March 2021.The basic information of the patients,including gender,age,body mass index(BMI),underlying diseases,and the Charlson comorbidity index(CCI)was calculated based on the underlying diseases.The preoperative serum cardiac troponin I(cTnI)level and the operation-related indicators were collected,including the type of cervical spine surgery,surgical procedure,approach,duration of surgery,duration of anesthesia,intraoperative bleeding,postoperative pain visual analogue scale(VAS),and electrolyte disturbances.Count data were expressed as cases(%),and comparisons between groups were made using the χ^(2) test;logistic regression models were applied to perform a multifactorial analysis of the factors influencing the perioperative occurrence of MACE in patients undergoing cervical spine surgery.Results Among the 426 patients,54(12.68%)experienced MACE during the perioperative period,including 4 cases of unstable angina(7.41%),4 cases of acute myocardial infarction(7.41%),33 cases of severe arrhythmia(61.11%),and 13 cases of acute heart failure(24.07%).The results of multivariate logistic regression analysis showed that the older the age group(50-59 years old:odds ratio=1.34,95%confidence interval:1.14-1.78;60-69 years old:odds ratio=1.48,95%confidence interval:1.20-1.86;70-79 years old:odds ratio=1.71,95%confidence interval:1.34-2.57;80-89 years old:odds ratio=1.95,95%confidence interval:1.46-2.85),as well as females,CCI scores>3,and preoperative cTnI>0.04μg/L,postoperative VAS score>5,and electrolyte disorders are all influencing factors for the occurrence of MACE in cervical spine surgery patients during the perioperative period(odds ratios of 1.84,2.12,2.34,2.57,2.20,95%confidence intervals of 1.34-2.68,1.50-3.41,1.63-3.72,1.53-4.01,1.43-3.69,a

关 键 词：颈椎手术 主要不良心脏事件 围术期 危险因素 

分 类 号：R687.3[医药卫生—骨科学]