有创机械辅助通气的非急诊非心脏手术老年患者术的后短期预后和危险因素分析

Analysis of short-termprognosis and risk factors in elderly patients undergoing non-emergency non-cardiac surgery with invasive mechanical ventilation

目的探讨有创机械通气的老年非急诊非心脏手术患者的短期不良心血管事件(MACE)情况,并分析其相关的危险因素。方法回顾性队列研究。选取2016年1月至2018年12月首钢医院重症监护科住院收治的170例老年行非急诊非心脏手术患者。随访60 d,按照是否发生MACE分为预后不良组(25例)和对照组(145例)。Cox回归分析评估影响MACE的相关因素。结果170例患者中,男性110例(64.7%),平均年龄(71.8±8.5)岁。平均随访(59.7±7.2)d,失访9例(5.3%)。MACE的平均发生时间为(13.7±4.1)d。同对照组比较,预后不良组的年龄较大,体质指数较低,陈旧心肌梗死比例更高,空腹血糖、高敏肌钙蛋白、B型利钠肽和术后48 h高敏肌钙蛋白峰值均较高,而舒张压和左室射血分数等较低(均为P<0.05)。Cox回归分析发现年龄(HR=1.81,95%CI:1.09~2.76)、体质指数(HR=1.54,95%CI:1.07~2.14)、B型利钠肽(HR=2.47,95%CI:1.76~3.47)、舒张压(HR=2.65,95%CI:1.84~3.82)和术后48 h高敏肌钙蛋白峰值(HR=2.17,95%CI:1.26~3.74)是发生MACE的危险因素(均为P<0.05)。结论有创机械通气的老年非急诊非心脏手术患者多于术后2周发生MACE,年龄、体质指数、B型利钠肽、舒张压和术后48 h高敏肌钙蛋白峰值是其高危因素。

Objective To explore the risk of short-term adverse cardiovascular events(MACE)in elderly non-emergency non-cardiac surgery patients,and analyze the related risk factors.Methods This study was a retrospective cohort study.A total of 170 elderly patients undergoing non-emergency non-cardiac surgery were enrolled from January 2016 to December 2018 in Beijing Shougang Hospital.Patients were divided into poor prognosis group and control group according to the MACE occurrence during a 60 days follow-up.Cox regression analysis was used to evaluate the risk factors of MACE.Results Among the 170 elderly patients,110 patients were males(64.7%)with an average age of(71.8±8.5)years.The average follow-up was(59.7±7.2)day and 9 cases(5.3%)were lost to follow-up.The average occurrence time of MACE was(13.7±4.1)days.Compared with the control group,the poor prognosis group had older age,lower body mass index(BMI),and higher proportion of old myocardial infarction and higher levels of fasting blood glucose,brain natriuretic peptide(BNP),and peak level of high-sensitivity troponin in 48 hours after surgery,and lower levels of diastolic blood pressure(DBP),and left ventricular ejection fraction(all P<0.05).Cox regression analysis revealed that age(HR=1.81,95%CI:1.09-2.76),BMI(HR=1.54,95%CI:1.07-2.14),BNP(HR=2.47,95%CI:1.76-3.47),DBP(HR=2.65,95%CI:1.84-3.82)and peak level of high-sensitivity troponin in 48 hours after surgery(HR=2.17,95%CI:1.26-3.74)were independent risk factors for MACE(all P<0.05).Conclusions MACE commonly occurs around 2 weeks after surgery in elderly non-emergency non-cardiac surgery patients with invasive mechanical ventilation.Age,BMI,BNP,DBP and peak level of hypersensitivity troponin in 48 hours after surgery are independent risk factors.