外科重症监护病房内非心脏手术患者围术期心血管问题对术后长期生存率的影响

Perioperative cardiovascular problems affect long-term survival in SICU patients undergoing noncardiac surgery

目的探讨外科重症监护病房(surgical intensive care unit,SICU)内的非心脏手术患者围术期心血管事件与2年生存率的关系。方法回顾性分析北京大学第一医院2013年3月至2015年3月1753例因非心脏手术后入住SICU患者的病例资料。记录所有患者的既往心血管病史,再收集术后重症病房住院期间新发心血管事件或既往心血管疾病加重的资料。所有患者转出重症医学科后予2年随访,统计分析其生存情况。结果截至转出重症医学科2年后,心血管病史组术后2年死亡率明显高于无心血管病史组(P=0.001),围术期出现心血管事件患者2年死亡率明显高于未出现围术期心血管事件患者(P<0.001)。多因素分析2年死亡率相关的独立危险因素包括既往冠状动脉粥样硬化性心脏病、围术期心力衰竭、围术期心肌缺血。结论非心脏手术SICU患者既往心血管病史及围术期心血管事件均会降低术后2年生存率,在治疗中应高度重视心血管疾病管理。

Objective To investigate the relationship between perioperative cardiac events and 2-year mortality in patients undergoing noncardiac surgery in SICU.Method 1753 patients who admitted into the SICU of the First Hospital of Peking University in 2013~2015 were enrolled.The previous cardiovascular disease history of all patients was recorded,and the data of new cardiac events or exacerbations of previous cardiovascular disease during their hospitalization in ICU were collected.All patients were followed up 2 years after discharge the ICU,and Logistic regression was performed to reveal an association between perioperative cardiovascular diseases and mortality.Result 2 years after the discharge of the ICU,the mortality of patients with previous history of cardiovascular diseases was significantly higher than that of patients without history of cardiovascular diseases(P=0.001).The mortality of patients with perioperative cardiac events was significantly higher than that of patients without perioperative cardiac events(P<0.001).Multivariate analysis of mortalityrelated risk factors include coronary heart disease,perioperative heart failure,and myocardial ischemia.Conclusion Previous history of cardiovascular disease and perioperative cardiac events in SICU patients undergoing noncardiac surgery can increased the mortality in two years.The management of perioperative cardiovascular disease should be emphasized in the treatment of SICU patients.