老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Study of the corelation between level of preoperative high-sensitivity C-reactive protein and incidence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery

目的研究老年非心脏手术患者术前高敏C反应蛋白（high-sensitivity C-reactive protein，hsCRP）与术后心脏不良事件发生之间的相关性。方法65岁以上行择期非心脏手术的患者49例，具有ACC／AHA“围术期心血管风险评估指南”中“临床病史危险因素分级”的至少1项中危因素或两项及以上低危因素。按术前所测hsCRP的水平分为2组即A组：hsCRP≤3mg／L组（n=21）和B组：hsCRP〉3mg／L组（n=28）。收集患者围术期一般资料，并在术前1周内任1d及术后行24h动态心电图监测；均实施术后镇痛，随访术后住院期间心脏不良事件的发生并记录术后住院天数。比较2组术后心脏不良事件发生情况及术后住院时间的差异。结果2组有19例术后发生心肌缺血，其中A组4例，B组15例；术后7例发生了其他的心脏不良事件，其中A组1例，B组6例。2组术后心肌缺血的发生率差异有统计学意义，但其他事件的发生率及术后住院时间差异无统计学意义。反应心肌缺血严重程度的指标：总压低时间A组（44±6）min、B组（135±81）min，压低阵次A组（5．2±2．5）次、B组（8．8±3．0）次，最长压低阵次A组（24±9）min、B组（84±54）min，缺血总负荷A组（170±89）mm·min^-1·24H^-1、B组（311±119）mm·min^-1·24h^-1，组间差异有统计学意义。结论老年患者术前hsCRP〉3mg／L与术后最常见的心脏不良事件——心肌缺血的发生之间具有相关性；术前hsCRP〉3mg／L是术后心肌缺血的危险因素之一；术前hsCRP水平的测定可能可以补充完善以往心血管风险评分系统。

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein（hsCRP） and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of ＂classification of risk factors for clinical history＂, content of ＂Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery＂ established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level：A group： hsCRP ≤ 3mg/L group （n=21） and B group： hsCRP〉3mg/L group （n =28 ）. General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia： total depression time is（43.5±5.82 ）min in A group, is（ 135.0±81.2 ）min in B group. The depression times is（5.2±2.5 ）in A group, is（ 8.8± 3.0）in B group.The longest depression time is（23.7±9.2）min in A group,is（84.3±54.1 ）min in B group.Total ischemia burden is（ 170.1± 88.8）mm·min^-1·24h^-1 in A group, is （311.3±118.8）mm·min^-1·24h^-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP〉3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events myocardial ischemia in elderly patients and level of preoperative hsCRP 〉3 mg/L was one of the risk factors of postoperative myocardial ischemia; Determination of preoperative bsCRP level may improve cardiovascular risk scoring system.