糖尿病患者非心脏手术围术期心血管事件危险因素分析

Risk factors of perioperative cardiovascular events in patients with diabetes undergoing non-cardiac surgery

目的探讨糖尿病患者非心脏手术围术期心血管事件的危险因素。方法择期行非心脏手术的糖尿病患者358例,记录术中、术后恶性心律失常、心肌缺血、不稳定性心绞痛、心肌梗死、心衰[射血分数(EF)<50%]等心血管事件,根据有无发生心血管事件分为心血管事件组和无心血管事件组,比较两组年龄、血糖、血脂、血压等,并进行多因素非条件Logistic回归分析。结果发生心血管事件组代谢紊乱情况明显,术前合并有冠心病、高血压,年龄、心衰、微量白蛋白尿增高、糖化血红蛋白增高的发生率均高于无心血管事件组,以上危险因素均与心血管事件发生呈正相关性(P<0.05)。结论年龄、糖尿病合并症(冠心病、心衰、肾病)是非心脏手术围术期心血管事件的主要危险因素。

Objective To analyze risk factors of perioperative cardiovascular events in patients with diabetes undergoing non-cardiac surgery. Methods A total of 358 patients with diabetes who underwent non-cardiac surgery were selected and were recorded the cardiovascular events before and after operation including malignant arrhythmia, myocardial ischemia, unstable angina, myocardial infarction and heart failure[ejection fraction （EF）〈50%]. The patients were divided into two groups according to whether there were adverse cardiovascular events. The patients were analyzed for age, glucose, blood pressure, dyslipidemia. The multifactorial cardiac risk indexes were obtained by stepwise logistic regression analysis. Results Cardiovascular events rate was higher in diabetic patients with coronary heart disease, hypertension, ages, heart failure, microalbuminuria, glycosylated hemoglobin than those in patients without adverse cardiovascular events, showing a positive correlation（P〈 0.05）. Conclusion Age, diabetes complications （such as diabetes with coronary artery disease,hypertension, heart failure）, microalbuminuria, glycosylated hemoglobin are major risk factors for the perioperative cardiovascular events in patients with diabetes.