CAJ | 학술논문

目的探讨非心脏手术后重症患者主要不良心脏事件的发病情况及其危险因素.了解非心脏手术后心肌损伤(myocardial injury after noncardiac surgery,MINS)的发生情况. 方法回顾性分析北京大学人民医院2012年1月至2013年1月非心脏手术后的重症患者1 087例,观察病史、术中情况、术后情况、心脏肌钙蛋白(cardiac troponin Ⅰ,cTNI)等临床指标,主要不良心脏事件定义为不稳定型心绞痛、非致命性心肌梗死,严重心律失常、心力衰竭、心血管死亡,采用Logistic回归分析非心脏手术后重症患者主要不良心脏事件的危险因素.结果非心脏手术后重症患者30 d主要不良心脏事件的发生率(94/1 087)8.6％,MINS发生率(168/1 087) 15.5％,Logistic回归分析发现年龄(OR1.03,95％CI1.01 ～1.05,P=0.002)、慢性肾功能不全病史(OR3.12,95％ CI 1.44 ～6.74,P=0.004)、术后24 h cTNI升高(OR2.04,95％CI 1.16 ～3.58,P=0.014)、术后24h使用升压药(OR 2.34,95％ CI1.25 ～4.38,P=0.008)是非心脏手术后重症患者主要不良心脏事件的危险因素.结论重症患者非心脏手术后主要不良心脏事件及MINS的发生率高,高龄、慢性肾功能不全病史、术后24 h cTNI升高、术后24 h使用升压药是导致非心脏手术后重症患者发生主要不良心脏事件的独立危险因素.
목적 탐토비심장수술후중증환자주요불양심장사건적발병정황급기위험인소.료해비심장수술후심기손상(myocardial injury after noncardiac surgery,MINS)적발생정황. 방법 회고성분석북경대학인민의원2012년1월지2013년1월비심장수술후적중증환자1 087례,관찰병사、술중정황、술후정황、심장기개단백(cardiac troponin Ⅰ,cTNI)등림상지표,주요불양심장사건정의위불은정형심교통、비치명성심기경사,엄중심률실상、심력쇠갈、심혈관사망,채용Logistic회귀분석비심장수술후중증환자주요불양심장사건적위험인소.결과 비심장수술후중증환자30 d주요불양심장사건적발생솔(94/1 087)8.6％,MINS발생솔(168/1 087) 15.5％,Logistic회귀분석발현년령(OR1.03,95％CI1.01 ～1.05,P=0.002)、만성신공능불전병사(OR3.12,95％ CI 1.44 ～6.74,P=0.004)、술후24 h cTNI승고(OR2.04,95％CI 1.16 ～3.58,P=0.014)、술후24h사용승압약(OR 2.34,95％ CI1.25 ～4.38,P=0.008)시비심장수술후중증환자주요불양심장사건적위험인소.결론 중증환자비심장수술후주요불양심장사건급MINS적발생솔고,고령、만성신공능불전병사、술후24 h cTNI승고、술후24 h사용승압약시도치비심장수술후중증환자발생주요불양심장사건적독립위험인소.
Objective To investigate the incidence and the risk factors of major adverse cardiac events of critical care patients after noncardiac surgery.To study the incidence of myocardial injury after noncardiac surgery (MINS).Methods A retrospective analysis of critical care patients (n =1 087) after noncardiac surgery from January 2012 to January 2013 in our hospital was carried out.The clinical data of the medical history, intraoperative conditions, postoperative conditions and cardiac troponin Ⅰ (cTNI) were collected.Major adverse cardiac events included unstable angina, non fatal myocardial infarction, severe arrhythmia, heart failure and cardiovascular death.Risk factors of major adverse cardiac events of critical care patients after noncardiac surgery were analyzed using Logistic regression.Results The 30 d non cardiac surgery incidence of major adverse cardiac events was (94/1 087) 8.6％, the incidence of MINS was (168/1 087) 15.5％, Logistic regression analysis showed that the risk factors of major adverse cardiac events after non cardiac surgery were age (OR 1.03,95％ CI 1.01-1.05, P =0.002), a history of chronic renal insufficiency(OR 3.12,95％ CI 1.44-6.74,P =0.004), rise of cTNI 24 h after operation (OR 2.04,95％ CI 1.16-3.58,P =0.014) and use of vasopressor drugs within 24 h after operation (OR 2.34,95％ CI 1.25-4.38,P =0.008).Conclusions The incidence of major adverse cardiac events and the MINS of critical care patients after noncardiac surgery is high.Old age, history of chronic renal insufficiency, rise of cTNI 24 h after operation and vasopressor drugs within 24 h after operation are the independent risk factors.