术前心电图检查对老年择期非心脏手术患者术后心血管并发症的预测价值

Predictive value of preoperative routine electrocardiography on postoperative cardiovascular complications in elderly undergoing schedualed non-cardiac surgery

目的探讨术前常规心电图(ECG)检查对老年择期非心脏手术患者术后心血管并发症的预测价值。方法本研究为回顾性队列研究,选择2012年11月15日至2013年01月15日期间在北京大学第一医院接受择期非心脏手术的老年患者(年龄≥60岁)为研究对象。记录术前ECG检查结果、患者围术期相关资料和术后住院期间的并发症。结果本研究有784名患者进入统计分析。术前ECG异常的整体发生率为35.1%。术后心血管并发症发生率在ECG正常组与ECG异常组之间无统计学差异(3.7%vs 3.6%,P=0.946)。术前ECG异常预测术后心血管并发症的ROC曲线下面积为0.547(95%CI:0.447~0.581,P=0.351)。多因素回归分析显示女性(OR=3.164,95%CI:1.365~7.335,P=0.007)、年龄增加(OR=1.131,95%CI:1.068~1.198,P<0.001)、美国麻醉医师协会(ASA)分级增高(OR=3.067,95%CI:1.394~6.750,P=0.005)、手术时间延长(OR=1.284,95%CI=1.045~1.489,P=0.014)是术后心血管并发症发生的独立危险因素。结论术前ECG检查对老年择期非心脏手术患者的术后心血管并发症预测价值有限。

Objective To determine the value of preoperative electrocardiogram （ ECG） in the prediction of postoperative cardio-vascular complications in elderly patients undergoing schedualed non-cardiac surgery .Methods A retrospective cohort study was carried out on the patients aged 60 years or older undergoing elective non-cardiac surgery in our department from November 15, 2012 to January 15, 2013.The results of preoperative ECG , perioperative data and postoperative complications during the hospital stay were recorded and analyzed.Results There were 784 patients included in the final analysis , and 275 of them （35.1%） were found having cardiac abnormality according to the results of ECG .There was no difference in the incidence of postoperative cardiovascular complica -tions between those patients with and without normal ECG preoperatively （3.7%vs 3.6%, P=0.946）.The area under ROC curve for postoperative cardiovascular complications predicted by abnormal preoperative ECG was 0.547 （95%CI：0.447-0.581, P=0.351）. Multivariate logistic regression analysis showed that female gender （ OR=3.164, 95%CI： 1.365 -7.335, P=0.007）, older age （OR=1.131, 95%CI： 1.068 -1.198, P 〈0.001 ）, higher grade of American Society of Anesthesiologists Classification （OR=3.067, 95%CI： 1.394 -6.750,P=0.005） and prolonged duration of surgery （OR =1.284, 95%CI：1.045 -1.489, P=0.014） were independent predictors of postoperative cardiovascular complications .Conclusion Preoperative ECG is of limited value in the prediction of postoperative cardiovascular complications in the elderly patients undergoing schedualed non -cardiac surgery .