手部手术患者围术期发生心血管事件的影响因素分析

The influence factor analysis of cardiovascular events during periopentive period undergoing hand surgery

目的探讨手部手术患者围术期发生心血管事件的相关影响因素。方法选择2009～2012在该院行手部手术的患者197例。记录患者一般状况、麻醉方式、手术时间、术中血流动力学变化（血压波动大于20％），随访并记录术后心血管事件发生情况，并进行因素分析。结果术后48h内发生心血管事件23例，总发生率为11．7％，其中窦速3例（1．52％），房颤2例（1．02％），室性早搏4例（2．03％），心肌缺血11例（5．58％），心绞痛3例（1．52％），心肌梗死l例（0．51％）。多因素Logistic回归分析显示，手部手术患者围术期心血管事件影响因素分别为糖尿病（OR=2．012，P=0．023）、冠心病（OR=2．301，P=0．028）、术前ST缺血改变（OR=2．942，P=0．031）、血脂异常（OR=3．012，P=0．019）、术中血流动力学改变（OR=3．522，P=0．020）。结论手部手术患者围术期心血管事件发生的独立危险因素为糖尿病、冠心病、术前ST缺血改变、术中血流动力学改变．

Objective To analysis the risk factors of cardiovascular events during periopemtive period undergoing hand surgery. Methods 197 cases of hand surgery in our hospital from 2009 to 2012 ,aged 21 to 74 years were selected. The general condition,an esthesia, operative time and intraoperative hemodynamics（blood pressure）〉 20 % ） were recorded, postoperative follow-up and record the occurrence of cardiovascular events,and factor analysis was carried on. Results In 48 hours,23 patients were suffered from car diovascular events, and the total morbidity rate was 11.7 % ,in which sinus tachycardia was 3 case（ 1.52 % ）, atrial fibrillation were 2 cases （ 1.02% ）, premature ventricular contractions were 4 cases （ 2.03 % ）, the myocardial ischemia were 11 cases （ 5.58% ）, the angi na pectoris were 3 cases（ 1. 52%）, the myocardial isehemia was lcase（0. 51%）. Multiariable Logistic regression analysis showed that,the influencing factors of perioperative cardiovascular events undergoing hand surgery were were diabetes mellitus （OR= 2. 012,P=0.023）,coronaryheartdisease （OR=2.301,P=0. 028） ,preoperative ST ischemic changes（OR=2. 942,P=0. 031） ,lip id abnormalities（OR=3. 012,P 0. 019） and hemodynamics changes during operation（OR 3. 522,P=0. 020）. Conclusion The risk factors of perioperative cardiovascular events independent undergoing hand surgery might be diabetes, coronary heart disease, preoperative ST ischemic changes,intraoperative hemodynamic changes.