非心脏手术围术期心脏骤停的影响因素分析

Analysis of influencing factors of perioperative cardiac arrest in non-cardiac surgery

目的 探讨非心脏手术围术期心脏骤停的影响因素,为围术期心脏骤停的预防和救治提供科学依据。方法选取2010—2020年北京大学第三医院非心脏手术的患者,采用1∶4巢式病例对照的研究设计,根据围术期心脏骤停与否分为心脏骤停组和对照组,采用多因素logistic回归方程分析非心脏手术围术期心脏骤停的影响因素。结果 共纳入非心脏手术患者559 502例,其中心脏骤停50例,心脏骤停发生率为0.89/万,因心脏骤停死亡13例,死亡率为0.23/万。心血管系统不良事件是围术期心脏骤停的主要原因,占70.00%。多因素logistic回归分析结果显示,急诊手术(OR=3.146,95%CI:1.533~6.491,P=0.001)、美国麻醉师协会(American Society of Anesthesiologist, ASA)Ⅲ级及以上(OR=6.894,95%CI:4.320~12.282,P=0.001)、全身麻醉(OR=1.127,95%CI:1.055~2.593,P=0.001)、多处手术部位(OR=6.181,95%CI:3.182~10.641,P=0.000)、夜间手术(OR=2.456,95%CI:1.877~4.131,P=0.000)和手术时长大于180 min(OR=1.533,95%CI:1.212~5.303,P=0.000)的非心脏手术患者,围术期发生心脏骤停风险较高。结论 急诊手术、ASAⅢ级及以上、全身麻醉、多处手术部位、夜间手术和手术时长大于180 min是非心脏手术围术期发生心脏骤停的危险因素,临床需高度关注。

Objective To explore the influencing factors of perioperative cardiac arrest in non-cardiac surgery,and to provide scientific basis for prevention and treatment of perioperative cardiac arrest.Methods The non-cardiac surgery patients in Peking University Third Hospital from 2010 to 2020 were selected,and the 1:4 nested case-control study design was adopted.The patients were divided into cardiac arrest group and control group according to cardiac arrest or not during the perioperative period.Multivariate logistic regression equation analysis was used to analyze the influencing factors of cardiac arrest during the perioperative period of non-cardiac surgery.Results A total of 559502 patients undergoing noncardiac surgery were included,including 50 cases of cardiac arrest,the incidence of cardiac arrest was 0.89/10000,and 13 cases died of cardiac arrest,with a mortality rate of 0.23/10000.Adverse events of cardiovascular system was the main cause of cardiac arrest during perioperative period,accounting for 70.00%.Multivariate logistic regression analysis showed that non-cardiac surgery patients with emergency surgery(OR=3.146,95%CI:1.533-6.491,P=0.001),American Society of Anesthesiologist(ASA)grade Ⅲ or above(OR=6.894,95%CI:4.320-12.282,P=0.001),general anesthesia(OR=1.127,95%CI:1.055-2.593,P=0.001),multiple surgical sites(OR=6.181,95%CI:3.182-10.641,P=0.000),night surgery(OR=2.456,95%CI:1.877-4.131,P=0.000)and surgery duration more than 180 min(OR=1.533,95%CI:1.212-5.303,P=0.000)were at higher risk of cardiac arrest during perioperative period.Conclusions Patients with emergency surgery,ASA grade Ⅲ or above,general anesthesia,multiple surgical sites,night surgery and surgery duration more than 180 min are risk factors for cardiac arrest during non-cardiac surgery,which should be highly concerned in clinic.