非心脏手术围术期心血管并发症危险因素分析
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摘要
[目的]探讨非心脏手术围术期心血管并发症的发生率和相关危险因素。
[方法]从2007年3月至2009年11月,收集1609例年龄超过40岁的择期非心脏手术患者的病例资料,采用统一的表格对术前、术中、术后的相关数据进行记录并随访患者住院期间心血管并发症的发生情况。通过Logistic回归的统计学方法得出围术期各心血管并发症的危险因素。
[结果]①.围术期124人发生了心血管并发症,发生率为7.7%,其中心肌缺血、心律失常、心肌梗死、心源性死亡的发生率分别为3.9%、3.3%、0.2%、0.3%。②.Logistic回归分析显示：心肌缺血的危险因素为年龄、ACC/AHA临床危险因素分层、METs<4、术前心绞痛史、脑血管病史(OR分别为1.060、2.936、34.266、11.703、11.082)；心律失常的危险因素为年龄及硬膜外麻醉(OR分别为1.068、0.436)；心肌梗死的危险因素是心肌梗死病史(OR为18.191)；心源性死亡的危险因素为心肌梗死病史及心绞痛史(OR分别为34.520、38.417)。
[结论]①.非心脏手术围术期心血管并发症发生率为7.7%,心源性死亡的发生率为0.3%。②.围术期心肌缺血的危险因素为年龄、ACC/AHA临床危险因素分层、METs<4、心绞痛史、脑血管病史；围术期心律失常的危险因素为年龄及硬膜外麻醉；围术期心肌梗死的危险因素是术前心肌梗死病史；围术期心源性死亡的危险因素为术前心肌梗死病史与心绞痛史。③.围术期心肌缺血的危险因素有多个,但不一定都引起心源性死亡。
[Objective] To investigate the incidence and risk factors of perioperative cardiovascular complications in patients undergoing noncardiac surgery.
[Methods] From March 2007 to November 2009, we collected the clinical data of 1609 patients over 40 years undergoing elective noncardiac surgery, using a standard table to record the relative date of preoperative, intraoperative and postoperative and followed up the occurrence of cardiovascular complications before discharge of hospital, adopting a statistical method of multivariate Logistic regression analysis to gain the perioperative risk factors of all patients during hospitalization.
[Results]①.There were 124 patients experiencing cardiovascular complications, the incidence rate was 7.7%, in which the incidence rate of myocardial ischemia, cardiac arrhythmias, myocardial infarction, cardiac death rates was 3.9%,3.3%,0.2%, 0.34%.②.The Logistic regression analysis showed:age, ACC/AHA clinical risk factors, metabolic equivalent levels(METs)<4, preoperative history of angina, history of cerebrovascular disease were the independent risk factors of perioperative myocardial ischemia (OR1.060,2.936,34.266,11.703,11.082); age and epidural anesthesia were the independent risk factors of perioperative arrhythmia (OR1.068, 0.436); preoperative myocardial infarction was an independent risk factor of perioperative myocardial infarction (OR18.191); preoperative myocardial infarction and angina pectoris were the independent risk factors of perioperative cardiac death (OR34.520,38.417).
[Conclusion]①. The incidence rate of perioperative cardiovascular complications in patients undergoing noncardiac surgery is 7.7%, in which the incidence rate of cardiac death is 0.3%.②. The factors of perioperative myocardial ischemia include age, ACC /AHA clinical risk factors, METs<4, preoperative history of angina, history of cerebrovascular disease; age and epidural anesthesia are the risk factors of perioperative arrhythmia; preoperative myocardial infarction is the risk factor of perioperative myocardial infarction; preoperative myocardial infarction and angina pectoris are the risk factors of perioperative cardiac death.③.There are many risk factors of perioperative myocardial ischemia, but not necessarily leading to cardiac death.
[方法]从2007年3月至2009年11月,收集1609例年龄超过40岁的择期非心脏手术患者的病例资料,采用统一的表格对术前、术中、术后的相关数据进行记录并随访患者住院期间心血管并发症的发生情况。通过Logistic回归的统计学方法得出围术期各心血管并发症的危险因素。
[结果]①.围术期124人发生了心血管并发症,发生率为7.7%,其中心肌缺血、心律失常、心肌梗死、心源性死亡的发生率分别为3.9%、3.3%、0.2%、0.3%。②.Logistic回归分析显示：心肌缺血的危险因素为年龄、ACC/AHA临床危险因素分层、METs<4、术前心绞痛史、脑血管病史(OR分别为1.060、2.936、34.266、11.703、11.082)；心律失常的危险因素为年龄及硬膜外麻醉(OR分别为1.068、0.436)；心肌梗死的危险因素是心肌梗死病史(OR为18.191)；心源性死亡的危险因素为心肌梗死病史及心绞痛史(OR分别为34.520、38.417)。
[结论]①.非心脏手术围术期心血管并发症发生率为7.7%,心源性死亡的发生率为0.3%。②.围术期心肌缺血的危险因素为年龄、ACC/AHA临床危险因素分层、METs<4、心绞痛史、脑血管病史；围术期心律失常的危险因素为年龄及硬膜外麻醉；围术期心肌梗死的危险因素是术前心肌梗死病史；围术期心源性死亡的危险因素为术前心肌梗死病史与心绞痛史。③.围术期心肌缺血的危险因素有多个,但不一定都引起心源性死亡。
[Objective] To investigate the incidence and risk factors of perioperative cardiovascular complications in patients undergoing noncardiac surgery.
[Methods] From March 2007 to November 2009, we collected the clinical data of 1609 patients over 40 years undergoing elective noncardiac surgery, using a standard table to record the relative date of preoperative, intraoperative and postoperative and followed up the occurrence of cardiovascular complications before discharge of hospital, adopting a statistical method of multivariate Logistic regression analysis to gain the perioperative risk factors of all patients during hospitalization.
[Results]①.There were 124 patients experiencing cardiovascular complications, the incidence rate was 7.7%, in which the incidence rate of myocardial ischemia, cardiac arrhythmias, myocardial infarction, cardiac death rates was 3.9%,3.3%,0.2%, 0.34%.②.The Logistic regression analysis showed:age, ACC/AHA clinical risk factors, metabolic equivalent levels(METs)<4, preoperative history of angina, history of cerebrovascular disease were the independent risk factors of perioperative myocardial ischemia (OR1.060,2.936,34.266,11.703,11.082); age and epidural anesthesia were the independent risk factors of perioperative arrhythmia (OR1.068, 0.436); preoperative myocardial infarction was an independent risk factor of perioperative myocardial infarction (OR18.191); preoperative myocardial infarction and angina pectoris were the independent risk factors of perioperative cardiac death (OR34.520,38.417).
[Conclusion]①. The incidence rate of perioperative cardiovascular complications in patients undergoing noncardiac surgery is 7.7%, in which the incidence rate of cardiac death is 0.3%.②. The factors of perioperative myocardial ischemia include age, ACC /AHA clinical risk factors, METs<4, preoperative history of angina, history of cerebrovascular disease; age and epidural anesthesia are the risk factors of perioperative arrhythmia; preoperative myocardial infarction is the risk factor of perioperative myocardial infarction; preoperative myocardial infarction and angina pectoris are the risk factors of perioperative cardiac death.③.There are many risk factors of perioperative myocardial ischemia, but not necessarily leading to cardiac death.
引文
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