腹腔内手术围手术期心血管事件及危险因素分析

Analysis of perioperative cardiovascular events and related risk factors in patients undergoing intraperitoneal surgery

目的调查腹腔内手术围手术期心血管事件发生率并分析相关危险因素。方法回顾2007年7月至2008年6月连续1079例腹腔内手术患者病历资料，用统一的表格对患者术前、术中及术后住院期间相关资料逐一进行记录后应用统计软件分析围手术期主要心血管事件发生率及危险因素。结果腹腔内手术围手术期主要心血管事件（心源性死亡、心脏骤停、非致死性心肌梗死）发生率为3．99％（43／1079），全因病死率为1．58％（17／1079）。腹腔内手术围手术期主要心血管事件的独立危险因素为年龄≥60岁、冠心病、心功能不全、心律失常病史、慢性阻塞性肺疾病病史、肾小球滤过率〈60ml／（min·1．73m^2）、急诊手术以及手术时间〉2．82h（OR=2．68—5．19，P=0．001—0．031）。结论中度危险的腹腔内手术围手术期主要心血管事件发生率为3．99％；老龄患者以及既往有心脏病史、慢性阻塞性肺疾病病史或肾功能异常的患者在进行腹腔内手术，尤其是急诊手术或手术时间长的大手术时需要警惕围手术期心血管事件的发生。

Objectives To investigate incidence of perioperative cardiovascular events, to analyze related risk factors for the patients undergoing intraperitoneal surgery. Methods The data of 1079 patients who underwent intraperitoneal surgery （exclude laparoscope surgery ） from July 2007 to June 2008 was reviewed and analyzed. Results For the patients undergoing intraperitoneal surgery, the incidence of major cardiovascular events was 3.99% （ 43/1079 ）, all-cause mortality was 1.58% （ 17/1079 ） . The independent risk factors of major cardiovascular events were age ≥60 years, history of coronary heart disease, cardiac insufficiency, arrhythmia, chronic obstructive pulmonary disease, estimated glomerular filtration rate （eGFR） 〈 60 ml/（ min · 1.73 m^2 ） , emergency surgery and duration of surgery 〉 2. 82 h （ OR = 2. 68 to 5. 19, P = 0. 001 to 0. 031 ）. Conclusions The cardiac risk of intraperitoneal surgery is 3.99%. The risk of cardiac complications should be evaluated in elderly patients and those with ischaemic heart disease, chronic obstructive pulmonary disease, and renal disease, more specifically, when emergent or long duration major surgeries are needed.