CAJ | 학술논문

目的研究老年非心脏手术患者术前高敏C反应蛋白(high-sensitivity C-reactive protein,hsCRP)与术后心脏不良事件发生之间的相关性. 方法 65岁以上行择期非心脏手术的患者49例,具有ACC/AHA"围术期心血管风险评估指南"中"临床病史危险因素分级"的至少1项中危因素或两项及以上低危因素.按术前所测hsCRP的水平分为2组即A组:hsCRP≤3mg/L组(n=21)和B组:hsCRP>3 mg/L组(n=28).收集患者围术期一般资料,并在术前1周内任1 d及术后行24 h动态心电图监测;均实施术后镇痛,随访术后住院期间心脏不良事件的发生并记录术后住院天数.比较2组术后心脏不良事件发生情况及术后住院时间的差异. 结果 2组有19例术后发生心肌缺血,其中A组4例,B组15例;术后7例发生了其他的心脏不良事件,其中A组1例,B组6例.2组术后心肌缺血的发生率差异有统计学意义,但其他事件的发生率及术后住院时间差异无统计学意义.反应心肌缺血严重程度的指标:总压低时间A组(44±6)min、B组(135±81)min,压低阵次A组(5.2±2.5)次、B组(8.8±3.0)次,最长压低阵次A组(24±9)min、B组(84±54)min,缺血总负荷A组(170±89)mm·min-1·24h-1、B组(311±119)mm·min-1·24 h-1,组间差异有统计学意义. 结论老年患者术前hsCRP>3 mg/L与术后最常见的心脏不良事件--心肌缺血的发生之间具有相关性;术前hsCRP>3mg/L是术后心肌缺血的危险因素之一;术前hsCRP水平的测定可能可以补充完善以往心血管风险评分系统.
목적 연구노년비심장수술환자술전고민C반응단백(high-sensitivity C-reactive protein,hsCRP)여술후심장불량사건발생지간적상관성. 방법 65세이상행택기비심장수술적환자49례,구유ACC/AHA"위술기심혈관풍험평고지남"중"림상병사위험인소분급"적지소1항중위인소혹량항급이상저위인소.안술전소측hsCRP적수평분위2조즉A조:hsCRP≤3mg/L조(n=21)화B조:hsCRP>3 mg/L조(n=28).수집환자위술기일반자료,병재술전1주내임1 d급술후행24 h동태심전도감측;균실시술후진통,수방술후주원기간심장불량사건적발생병기록술후주원천수.비교2조술후심장불량사건발생정황급술후주원시간적차이. 결과 2조유19례술후발생심기결혈,기중A조4례,B조15례;술후7례발생료기타적심장불량사건,기중A조1례,B조6례.2조술후심기결혈적발생솔차이유통계학의의,단기타사건적발생솔급술후주원시간차이무통계학의의.반응심기결혈엄중정도적지표:총압저시간A조(44±6)min、B조(135±81)min,압저진차A조(5.2±2.5)차、B조(8.8±3.0)차,최장압저진차A조(24±9)min、B조(84±54)min,결혈총부하A조(170±89)mm·min-1·24h-1、B조(311±119)mm·min-1·24 h-1,조간차이유통계학의의. 결론 노년환자술전hsCRP>3 mg/L여술후최상견적심장불량사건--심기결혈적발생지간구유상관성;술전hsCRP>3mg/L시술후심기결혈적위험인소지일;술전hsCRP수평적측정가능가이보충완선이왕심혈관풍험평분계통.
Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.