腹部手术后重症患者并发心肌损伤的高危因素分析

Risk factors associated with myocardial injury after non-cardiac major surgery in ICU admitted patients

目的探讨影响腹部手术后重症患者发生心肌损伤的高危因素,为临床早期防治该病提供参考。方法回顾性分析2016年1月至2018年12月间北京大学人民医院ICU收治的腹部手术后322例患者的临床资料,采用Ugistic回归分析患者在手术后并发心肌损伤的危险因素。结果本组322例患者中156例患者(48.4%)发生心肌损伤,其中入ICU 72 h内发生心肌损伤的患者共152例(97.4%)。多因素分析结果显示,年龄>65岁(OR=1.747,P=0.021)、BMI大(OR=1.085,P=0.008)、急性生理和慢性健康评分Ⅱ高(OR=1.066,P=0.047)、合并高血压病(OR=1.727,P=0.027)、术后血乳酸水平升高(0R=1.393,P=0.001)以及合并急性肾损伤(OR=2.065,P=0.047)的患者发生心肌损伤的风险高。结论腹部手术后重症患者是心肌损伤的高发人群;高龄、BMI大、病情重、合并高血压病、术后出现血乳酸水平增高以及新发急性肾损伤是患者发生心肌损伤的独立危险因素。

Objective To analyze the risk factors related to the myocardial injury after non-cardiac surgery(MINS)in patients who underwent major abdominal surgery.Methods The clinical data of all patients admitted in the surgical ICU of Peking University People's Hospital from Jan 2016 to Dec 2018 were analyzed.Logistic multivariate analysis was performed to analyze the association of clinical characteristics with the incidence of MINS.Results A total of 322 patients were included,48.4%(156/322)were diagnosed as with MINS.97.4%(152/156)of MINS occurred during the first 72 h of admission.Multivariate analysis showed that independent predictive factors of MINS were age>65y(OR=1.747,P=0.021),body mass index(OR=1.085,P=0.008),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ,OR=1.066;P=0.047),hypertension(OR=1.747,P=0.027),blood lactate(OR=1.393,P=0.001)and acute kidney injury(OR=2.065,P=0.047).Conclusions The incidence of MINS in patients who underwent major abdominal surgery was high.Age,body mass index,APACHE H score,hypertension,blood lactate level and acute kidney injury after surgery were independent risk factors of MINS.