中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
15期
2771-2774
,共4页
心肌缺血%非心血管手术%心血管事件
心肌缺血%非心血管手術%心血管事件
심기결혈%비심혈관수술%심혈관사건
Myocardial ischemia%Noncardiovascular surgery%Cardiovascular event
目的：通过对冠心病患者或有冠心病危险因素患者术后心肌缺血和心血管事件的临床研究，探讨围术期心肌缺血的危险因素。方法参照美国心脏病学会/美国心脏协会（ACC/AHA）的“围手术期心血管风险”预测标准共入选病例98例。患者入手术室后行Holter监测，持续至术后48 h，术后患者入住SICU病房，监测相关指标：血流动力学监测、血气分析、电解质、应激水平（血皮质醇、血糖、白细胞介素-6）、肌钙蛋白I、体温监测、疼痛评分，术后随访至患者出院。根据Holter监测分析结果将患者分为术后心肌缺血组和非缺血组，两组间各监测指标先行单因素分析，有意义的指标再行Logistic回归分析。结果缺血组和非缺血组间心血管事件发生差异有统计学意义（P＜0.05），缺血组心动过速、低血压、低体温、低氧血症高于非缺血组（P＜0.05）；经多因素 Logistic回归分析，心动过速、低血压、低体温、低氧血症是围术期心肌缺血的危险因素（P＜0.05）。结论术后心肌缺血是术后心血管事件的预警指标，心动过速、低血压、低体温、低氧血症是术后心肌缺血的危险因素。
目的：通過對冠心病患者或有冠心病危險因素患者術後心肌缺血和心血管事件的臨床研究，探討圍術期心肌缺血的危險因素。方法參照美國心髒病學會/美國心髒協會（ACC/AHA）的“圍手術期心血管風險”預測標準共入選病例98例。患者入手術室後行Holter鑑測，持續至術後48 h，術後患者入住SICU病房，鑑測相關指標：血流動力學鑑測、血氣分析、電解質、應激水平（血皮質醇、血糖、白細胞介素-6）、肌鈣蛋白I、體溫鑑測、疼痛評分，術後隨訪至患者齣院。根據Holter鑑測分析結果將患者分為術後心肌缺血組和非缺血組，兩組間各鑑測指標先行單因素分析，有意義的指標再行Logistic迴歸分析。結果缺血組和非缺血組間心血管事件髮生差異有統計學意義（P＜0.05），缺血組心動過速、低血壓、低體溫、低氧血癥高于非缺血組（P＜0.05）；經多因素 Logistic迴歸分析，心動過速、低血壓、低體溫、低氧血癥是圍術期心肌缺血的危險因素（P＜0.05）。結論術後心肌缺血是術後心血管事件的預警指標，心動過速、低血壓、低體溫、低氧血癥是術後心肌缺血的危險因素。
목적：통과대관심병환자혹유관심병위험인소환자술후심기결혈화심혈관사건적림상연구，탐토위술기심기결혈적위험인소。방법삼조미국심장병학회/미국심장협회（ACC/AHA）적“위수술기심혈관풍험”예측표준공입선병례98례。환자입수술실후행Holter감측，지속지술후48 h，술후환자입주SICU병방，감측상관지표：혈류동역학감측、혈기분석、전해질、응격수평（혈피질순、혈당、백세포개소-6）、기개단백I、체온감측、동통평분，술후수방지환자출원。근거Holter감측분석결과장환자분위술후심기결혈조화비결혈조，량조간각감측지표선행단인소분석，유의의적지표재행Logistic회귀분석。결과결혈조화비결혈조간심혈관사건발생차이유통계학의의（P＜0.05），결혈조심동과속、저혈압、저체온、저양혈증고우비결혈조（P＜0.05）；경다인소 Logistic회귀분석，심동과속、저혈압、저체온、저양혈증시위술기심기결혈적위험인소（P＜0.05）。결론술후심기결혈시술후심혈관사건적예경지표，심동과속、저혈압、저체온、저양혈증시술후심기결혈적위험인소。
Objective Analyzing postoperative myocardial ischemia and cardiovascular events in patients with coronary heart disease or risk factors of coronary heart disease, to search the predisposing cause of postoperative myocardial ischemia and meaningful monitoring marks. Methods According to the “ACC/AHA Guideline for Perioperative Cardiovascular Evaluation for Noncardiac Surgery”, ninety-eight patients were collected after preoperative interview. Patients were monitored with Holter system as they were carried into operation rooms. After surgery, patients were monitored and treated aggressively in SICU. Monitoring marks included bloodstream dynamics, blood gas analysis, electrolyte, stress level(corticosteroids, blood glucose, IL-6), cardiac troponin I, temperature, pain score. Holter monitoring lasted 48 hours during postoperative period. Patients were followed in hospital. According to the results of the Holter monitoring, patients were classified into postoperative ischemic group and non-ischemic group. Results were compared using t or χ2 statistic between two groups. Logistic regression were attempted in multivariate analysis. Results The rate of cardiovascular events in ischemic group was significantly higher than that in non-ischemic group(P<0.05). The rates of tachycardia, hypotension, hypothermia and hypoxemia in ischemic group were significantly higher than that in non-ischemic group, showing a positive correlation(P<0.05). Conclusions Postoperative myocardial ischemia is the alarming mark of postoperative cardiovascular events. Tachycardia, hypotension, hypothermia and hypoxemia are the risk factors of postoperative myocardial ischemia.
