血栓前状态预测老年冠心病非心脏手术患者围术期心脏事件的价值

Value of prethrombotic state in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery

目的 评价血栓前状态（PTS）预测老年冠心病非心脏手术患者围术期心脏事件的价值.方法 择期全麻下行腹部手术的冠心病老年患者128例,年龄65 ～ 75岁,性别不限,ASA分级Ⅰ或Ⅱ级,NYHA分级Ⅰ或Ⅱ级.采用全凭静脉麻醉.术前采集静脉血样,测定血浆D-二聚体、血栓前体蛋白及P-选择素的浓度,根据此3项指标判断是否存在PTS.根据术中和术后3d内是否发生心脏事件分为非心脏事件组和心脏事件组.记录患者一般资料及术中情况各指标,将组间差异有统计学意义的因素进行logistic回归分析,筛选心脏事件的危险因素.结果 29例患者发生心脏事件,与非心脏事件组比较,心脏事件组年龄、肥胖、糖尿病比率、手术时间和PTS比率差异有统计学意义（P＜ 0.05或0.01）；logistic回归结果显示：高龄、糖尿病、手术时间长和PTS是心脏事件的独立危险因素（P＜O.O1）.结论 PTS对老年冠心病非心脏手术围术期心脏事件的发生有一定的预测价值.

Objective To investigate the value of prothrombotic state （PTS） in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.Methods One-hundred and twenty-eight ASA physical status Ⅰ or Ⅱ elderly patients （NYHA class Ⅰ or Ⅱ） of both sexes,aged 6575 yr,undergoing elective abdominal surgery,were enrolled in the study.Total intravenous anesthesia was performed during surgery.Venous blood samples were collected for detection of the levels of D-dimer,thrombus precursor protein and P-selectin （molecular markers of PTS）.Detection of PTS was based on the three indexes mentioned above.The patients were divided into 2 groups according to the cardiac events occurred during surgery and within 3 days after surgery：non-cardiac event group and cardiac event group.The general data of patients and each index during surgery were recorded.Logistic regression analysis was used to pick out the potential risk factors for cardiac events.Results Twenty-nine patients developed cardiac events.There was no significant difference in age,obesity,ratio of diabetes,duration of operation,and ratio of PTS between non-cardiac event and cardiac event groups （P ＜ 0.05 or 0.01）.Logistic regression analysis showed that old age,diabetes,prolonged duration of operation,and PTS were independent risk factors for cardiac events （P ＜ 0.01）.Conclusion PTS produces some value in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.