老年冠心病患者行非心脏手术后心脏事件发生的危险因素

摘要

目的 评价老年冠心病患者非心脏手术,术后心脏事件的发生和危险因素.方法 行多中心、前瞻性队列研究,自2008年1月-2009年12月在5家中心纳入年龄≥60岁择期行中危或高危非心脏手术的冠心病患者1 510例,记录术前基本情况,监测术前、术后即刻及3d的12导联心电图和生化检测肌钙蛋白Ⅰ(cTnI)水平,随访住院期间心脏事件.结果 术后住院期间发生心脏事件104例(6.9％),心源性死亡9例(0.6％).影响术后心脏事件发生的5项独立的风险因素分别是年龄≥75岁、心肌梗死病史、高危手术、术中低血压和术中低氧血症.结论 年龄超过75岁、既往心肌梗死病史和接受高风险手术分别增加老年冠心病患者行非心脏手术后心脏事件的发生风险,在手术中防止低氧血症和低血压的发生,应该有助于减少术后心脏事件的发生,改善预后.%Objective To determine the preoperative and intraoperative predictors of postoperative cardiac events (PCE) in elderly patients with coronary artery disease (CAD) undergoing non-cardiac surgery.Methods 1 510 elderly CAD patients,aged 60 years and older,who underwent intermediate-to high-risk non-cardiac surgery at five academic medical centers in China,were enrolled in this prospective observational study from Jan.2008 to Dec.2009.Clinical variables were evaluated,The PCE were followed by the examinations of 12-lead ECG and Troponin Ⅰ(cTnI) levels.Results PCE occurred in 104 patients (6.9％).Cardiac death occurred in 9patients (0.6％).The independent risk factors were age ≥ 75 years old,history of MI,high-risk surgery,intraoperative hypoxemia,and intraoperative hypotension.Conclusions Age ≥ 75 years old,or history of MI,or highrisk surgery could increase the risk of PCE in CAD patients individually.Preventing intraoperative hypoxemia and hypotension may reduce the occurrence of PCE in these high risk patients.