脊柱减压固定融合术后症状性心血管事件发生率及危险因素分析

Prevalence and risk factors of postoperative symptomatic myocardial ischemia in surgically treated patients with degenerative spinal disorders

目的分析脊柱减压固定融合术后症状性心血管事件(SMI)的发生率及危险因素,为手术方案制定和临床决策提供参考。方法回顾性分析2015年1月—2016年12月河北医科大学第三医院脊柱外科接受脊柱减压、固定、融合手术治疗的462例患者临床资料,依据住院期间是否发生SMI分为观察组(61例)和对照组(401例)。比较两组患者一般资料、术前心脏功能评估指标、手术因素、术后因素。采用二分类logistic回归分析探讨术后SMI发生的危险因素。结果462例患者中61例(13.2%)术后发生SMI。与对照组比较,观察组的年龄更大(60.7岁:52.3岁)、心肌缺血病史和心脏手术史占比更高(分别为24/61:50/401和23/61:23/401)、颈椎手术占比也更高(38/61:168/401),而术中舒张压(77.0mmHg:80.5mmHg,1mmHg=0.133kPa)、术后次日血清Ca2+浓度则较低(2.2mol/L:2.3mol/L),差异均有统计学意义(P值均<0.05)。logistic回归分析显示:术后次日血清Ca2+浓度低于2.2mmol/L、心脏手术史、年龄>55岁与SMI发生具有显著相关性(P值均<0.05)。结论脊柱减压固定融合术后SMI的发生率为13.2%,危险因素包括患者年龄>55岁、术后低血钙和心脏手术史。对于老年患者和既往行心脏手术的患者,术前需详细告知风险,术后监测电解质是必要的。

Objective To evaluate the prevalence and risk factors of postoperative symptomatic myocardial ischemia(SMI)in surgically treated patients with degenerative spinal disorders so as to provide references in decision making and surgical planning for spinal surgeons.Methods By retrieving the medical records from January 2015 to December 2016,462 patients were retrospectively reviewed.According to the occurrence of postoperative symptomatic myocardial ischemia,patients were divided into two groups: observation group (61 patients)and control group (401 patients).To investigate risk factors,four categorized factors were analyzed such as patient characteristics variables,preoperative cardiac functional variables,intra-operative variables,postoperative variables.Risk factors of postoperative SMI were investigated by using the two-category logistic regression analysis.Results Postoperative SMI was seen in 61 of 462 patients(13.2%).Compared with control group,the patients'ages were older (60.7vs.52.3), patients with previous cardiac disease (24/61vs.50/401) or received previous cardiac surgery (23/61vs. 23/401) were much more,cervical disease were more common (38/61vs.168/401),diastolic blood pressure were lower (77.0 mmHg vs.80.5 mmHg,1 mmHg =0.133kPa)and serum Ca2+ concentration were lower (2.2mol/L vs.2.3mol/L)in observation group.There were significant differences between the two groups (all P values <0.05).Logistic regression analysis revealed that serum calcium concentration was less than 2.2 mmol/L,previous cardiac surgery and age older than 55years were independently associated with postoperative symptomatic myocardial ischemia (all P values <0.05).Conclusions The prevalence of postoperative symptomatic myocardial ischemia in surgically treated patients with degenerative spinal disorders is 13.2%,potential risk factors include serum calcium concentration less than 2.2 mmol/L, previous cardiac surgery and age older than 55 years.Based on the findings,patients received previous cardiac surgery and old patients should be fully informed the risk of postoperative SMI.For spinal surgeons,it is essential to monitor the serum calcium in postoperative patient management.