CAJ | 학술논문

目的：调查腹腔内手术围手术期心血管事件发生率，分析心血管危险评估指标（RCRI）评估腹腔内手术围手术期心血管风险的适用性。方法：腹腔内手术患者1079例分别用美国麻醉医师协会（ASA）体格情况分级、Gold-man指数及RCRI进行分级，统计各级心血管事件发生率及全因死亡率并进行比较分析。结果：（1）围手术期心血管事件发生率：主要心血管事件43例（3.99%），心血管事件74例（6.86%），全因死亡17例（1.58%）。（2）主要心血管事件发生率：①ASA体格情况分级Ⅰ~Ⅳ级相对应的主要心血管事件发生率为0%、2.28%、12.58%、42.86%。②Goldman指数Ⅰ~Ⅲ级相对应的主要心血管事件发生率为1.11%、6.42%、10.53%。③RCRIⅡ~Ⅳ级相对应的主要心血管事件发生率为2.36%、8.61%、23.08%。（3）预测事件的ROC曲线下面积：①ASA体格情况分级为0.73~0.76；②Goldman指数为0.66~0.70；③RCRI指数为0.63~0.68，三者比较差异无统计学意义（P＞0.05）。结论：RCRI可以客观、简便地评估腹腔内手术围手术期心血管风险，其预测准确性与ASA体格情况分级及Goldman指数相当。
목적：조사복강내수술위수술기심혈관사건발생솔，분석심혈관위험평고지표（RCRI）평고복강내수술위수술기심혈관풍험적괄용성。방법：복강내수술환자1079례분별용미국마취의사협회（ASA）체격정황분급、Gold-man지수급RCRI진행분급，통계각급심혈관사건발생솔급전인사망솔병진행비교분석。결과：（1）위수술기심혈관사건발생솔：주요심혈관사건43례（3.99%），심혈관사건74례（6.86%），전인사망17례（1.58%）。（2）주요심혈관사건발생솔：①ASA체격정황분급Ⅰ~Ⅳ급상대응적주요심혈관사건발생솔위0%、2.28%、12.58%、42.86%。②Goldman지수Ⅰ~Ⅲ급상대응적주요심혈관사건발생솔위1.11%、6.42%、10.53%。③RCRIⅡ~Ⅳ급상대응적주요심혈관사건발생솔위2.36%、8.61%、23.08%。（3）예측사건적ROC곡선하면적：①ASA체격정황분급위0.73~0.76；②Goldman지수위0.66~0.70；③RCRI지수위0.63~0.68，삼자비교차이무통계학의의（P＞0.05）。결론：RCRI가이객관、간편지평고복강내수술위수술기심혈관풍험，기예측준학성여ASA체격정황분급급Goldman지수상당。
Objective: The study was designed to investigate incidence of perioperative cardiovascular events and e-valuate the applicability of RCRI(Revised Cardiac Risk Index), for the patients undergoing intraperitoneal surgery. Method:1079 patients who underwent intraperitoneal surgery (exclude laparoscope surgery) were classified by ASA physical status, Goldman’s index and RCRI;Incidence of cardiovascular events and all-cause mortality of different class were analysed and compared. Result: For the patients undergoing intraperitoneal surgery, the incidence of major cardiovascular events was 3.99%, the incidence of cardiovascular events was 6.86%, all-cause mortality was 1.58%. The incidence of major cardio-vascular events with ASA physical statusⅠ~Ⅳ were 0%, 2.28%, 12.58% and 42.86%; and with Goldman index ClassⅠ~Ⅲwere 1.11%, 6.42%and 10.53%;and with RCRI ClassⅡ~Ⅳwere 2.36%, 8.61%and 23.08%. As to evaluate the pre-dictability of cardiac events, the area under ROC curve of these three indexes were 0.73~0.76, 0.66~0.70 and 0.63~0.68, with no statistical difference. Conclusion: Revised Cardiac Risk Index could be objective and easy to assess perioperative cardiovascular risk of intraperitoneal surgery, with similar prediction accuracy to ASA physical status or Goldman’s index.