吸入和静脉麻醉对老年冠心病患者术后不良心血管事件控制影响的对比研究

Comparison of effects of inhaled anesthesia and intravenous anesthesia on postoperative adverse cardiovascular events in elderly patients with coronary artery disease

目的比较吸入麻醉和静脉麻醉分别对老年冠心病患者术后效果及不良心血管事件控制的影响.方法选择接受择期非心脏手术治疗的老年冠心病患者1500例,按照麻醉方式分为静脉麻醉组(n=680)与吸入麻醉组(n=820).比较两组患者术后心功能指标水平、心血管不良事件发生率,并对术后心血管不良事件的高危因素进行多元logistic回归分析.结果两组患者术后肌酸激酶与心脏肌钙蛋白T水平比较,差异均无统计学意义(t分别=0.85、1.03,P均>0.05).吸入麻醉组术后心力衰竭、心肌梗死、心源性猝死、心律失常以及心血管不良事件总发生率均低于静脉麻醉组,差异均有统计学意义(χ^2分别=5.77、6.20、8.10、7.73、6.95,P均<0.05),两组在心源性休克发生率比较,差异无统计学意义(χ^2=0.10,P>0.05).影响术后不良心血管事件发生的多元logistic回归分析显示,静脉麻醉与术中高血压是影响老年冠脉患者术后不良心血管事件发生的高危因素(OR分别=1.20、0.91,P均<0.05).结论吸入麻醉方案能对老年冠脉手术患者心脏具有一定的保护效果,可有效降低患者术后不良心血管事件的发生风险,具有较高的临床应用价值;但静脉麻醉方案可能与术后不良心血管事件相关,临床应用价值不高.

Objective To compare the effects of inhaled anesthesia and intravenous anesthesia on postoperative adverse cardiovascular events in elderly patients with coronary artery disease. Methods Totally 1500 elderly patients with coronary artery disease were divided into intravenous anesthesia group(n=680)and inhalation anesthesia group(n=820)according to different anesthesia methods.The postoperative cardiac function parameters and the incidence of postoperative adverse cardiovascular events were compared. Multivariate logistic regression analysis was performed to analyze the risk factors for postoperative adverse cardiovascular events. Results There was no significant difference in creatine kinase and cardiac troponin T between the two groups(t=0.85,1.03,P>0.05).The incidence of heart failure,myocardial infarction,sudden cardiac death,arrhythmia,and total incidence of adverse cardiovascular events of inhalation anesthesia group were lower than those in intravenous anesthesia group(χ^2=5.77,6.20,8.10,7.73,6.95,P<0.05).There was no significant difference in the incidence of cardiogenic shock between the two groups(χ^2=0.10,P>0.05).Multivariate logistic regression analysis showed that intravenous anesthesia and intraoperative hypertension are high risk factors for adverse cardiovascular events in elderly patients with coronary artery disease(OR=1.20,0.91,P<0.05). Conclusion Inhalation anesthesia can effectively reduce the risk of postoperative adverse cardiovascular events.Intravenous anesthesia may be associated with postoperative adverse cardiovascular events in elderly patients undergoing coronary surgery.