高血压患者非心脏手术围手术期发生心脏事件的危险因素分析

摘要

Objective To investigate the independent risk factors of perioperative cardiac events in hypertensive patients undergone non-cardiac surgery. Methods Hypertensive patients (n=245, male 123 and female 122) were chosen from Jan. 2012 to Dec. 2016. All patients received time-selected non-cardiac surgery. The patients were divided, according to cardiac event occurring state, into cardiac event group (n=55) and non-cardiac event group (n=190). The data of medical records, including surgery data, medical history, electrocardiogram (ECG) and laboratory test results, were collected from the patients. Perioperative cardiac events were taken as ending events including unstable angina pectoris (UAP), cardiac death, acute myocardial infarction (AMI), congestive heart failure (CHF), malignant arrhythmia and non-fatal cardiac arrest during or after surgery (only in hospital). Results Compared with non-cardiac event group, the percentages of cases with CHD history, cardiac functional capacity≤4METs, ST-segment depression≥0.05 mV and transfusion of concentrated red blood cells (CRBC) during surgery increased in cardiac event group (all P<0.05). The results of multi-factor Logistic regression analysis showed that CHD history (OR=4.672, 95%CI: 1.648~12.990), cardiac functional capacity≤4METs (OR=2.727, 95%CI: 1.079~6.892), ST-segment depression≥0.05 mV (OR=4.642, 95%CI: 1.865~11.557) and transfusion of CRBC during surgery (OR=7.102, 95%CI: 2.791~18.073) were independent risk factors of perioperative cardiac events during non-cardiac surgery. The area under receiver operating characteristic curve (ROC) of above 4 risk factors was, respectively, 0.757, 0.693, 0.656 and 0.672. Conclusion The independent risk factors of perioperative cardiac events during non-cardiac surgery are CHD history, cardiac functional capacity≤4METs, ST-segment depression≥0.05 mV and transfusion of CRBC during surgery in hypertensive patients undergone non-cardiac surgery. CHD history is more accurate in predicting perioperative cardiac events occurrence.%目的 探讨高血压患者行非心脏手术围手术期发生心脏事件的独立危险因素.方法 选取罗定市人民医院心内科于2012年1月~2016年12月收治的高血压患者245例,均择期行非心脏手术,男性123例,女性122例.依据围手术期是否发生心脏事件分为发生心脏事件组(n=55)和未发生心脏事件组(n=190).收集入选患者的病历资料,包括手术资料、病史、心电图以及实验室检查结果等.围手术期心脏事件为结局事件,包括术中及术后(仅限住院期间)发生的不稳定型心绞痛、心源性死亡、急性心肌梗死、充血性心力衰竭、严重的心律失常、非致死性心跳骤停等.结果 与未发生心脏事件组比较,发生心脏事件组冠心病病史、METs≤4、ST段压低≥0.05 mV的比例以及术中输浓缩红细胞均升高,差异有统计学意义(P均<0.05).多因素Logistic回归分析显示,冠心病病史(OR=4.672,95%CI:1.648~12.990),METs≤4(OR=2.727,95%CI:1.079~6.892),ST段压低≥0.05 mV(OR=4.642, 95%CI:1.865~11.557),术中输浓缩红细胞(OR=7.102,95%CI:2.791~18.073)为高血压患者非心脏手术围手术期发生心脏事件的独立危险因素.上述危险因素预测围手术期心脏事件的受试者工作特征(ROC)曲线下面积分别为:0.757、0.693、0.656、0.672.结论 高血压患者非心脏手术围手术期发生心脏事件的独立危险因素分别为冠心病病史、METs≤4、ST段压低≥0.05 mV、术中输浓缩红细胞,冠心病病史预测围手术期心脏事件发生的准确性更高.