老年冠心病患者行骨科手术围术期心脏事件的危险因素

Risk factors for perioperative major adverse cardiac events in elderly patients with coronary heart disease undergoing orthopedic surgery

目的筛选老年冠心病患者行骨科手术围术期主要心脏事件（MACEs）的危险因素。方法选择行择期中危或高危骨科手术的冠心病患者129例，年龄≥65岁，性别不限。根据术中及术后30d内是否发生MACEs，将患者分为MACEs组和非MACEs组。记录患者年龄、性别、冠状动脉重建史、心肌梗死史、心力衰竭史、心绞痛史、全身血管病史、脑血管病史、糖尿病史、基础血压、术前血压、术前血常规、肌酐、血糖、心电图、超声心动图、ASA分级、术中输血、手术及麻醉时间、术后是否返ICU及术后引流量。将组间差异有统计学意义的因素进行多因素logistic回归分析，筛选该人群围术期MACEs的危险因素。结果21例患者发生围术期MACEs，发生率为16．3％。logistic回归分析结果显示：半年内不稳定型心绞痛史、术前红细胞压积≤35％、术前心电图示心律失常及室壁运动异常为老年冠心病患者行骨科手术围术期MACEs的危险因素（P〈0．05），其危险指数分别为5、3、3、4。结论半年内不稳定型心绞痛史、术前红细胞压积≤35％、术前心电图示心律失常及室壁运动异常是老年冠心病患者行骨科手术围术期MACEs的危险因素。

Objective To identify the risk factors for perioperative major adverse cardiac events （MACEs） in elderly patients with coronary heart disease （CHD） undergoing orthopedic surgery. Methods One hundred and twenty-nine patients with CHD, aged ≥ 65 yr, undergoing elective major orthopedic surgery in our hospital from January 2004 to December 2009, were selected. The patients were assigned into MACE group or non-MACE group according to the occurrence of MACEs during surgery and within 30 days after surgery. Age, sex, history of coro- nary reconstruction, myocardial infarction, heart failure, angina, systemic angionosis, cercbrovascular disease and diabetes, basic and preoperative blood pressure, routine blood test, serum creatinine, blood glucose, preoperative electrocardiography （ECG） and ultrasonic cardiography, ASA, intraoperative blood transfusion, operation and an- esthesia time, entering ICU after surgery and postoperative volume of drainage were recorded. If there was signifi- cant difference between the 2 groups, the factor was analyzed using multi-factor logistic regression to select the risk factors for incidence of MACEs. Results Twenty-one patients developed perioperative MACEs （16.3 % ）. Logistic regression analysis showed that unstable angina within 6 months, preoperative haematocrit ≤ 35 % , preoperative ECG arrhythmia and wall motion abnormality were risk factors for incidence of perioperative MACEs in this popula- tion （ P 〈 0.05）, and the risk indexes of the factors were 5, 3, 3 and 4, respectively. Conclusion Unstable an- gina within 6 months, preoperative haematocrit ≤ 35 %, preoperative ECG arrhythmia and wall motion abnormality are risk factors for perioperative MACEs in elderly patients with CHD undergoing orthopedic surgery.