目的:研究腹主动脉瘤切除术后心脏损伤的预测因素.方法:收集72例50岁以上行腹主动脉瘤手术患者临床资料,测定术前及术后24 h肌钙蛋白I(cTnI)浓度,分为cTnI升高组与正常组,比较2组的临床资料,采用x2检验与Logistic回归分析确定心脏损伤的预测因素.结果:72例行腹主动脉瘤切除术的患者,术后CTnI升高者30例,发生率为41.7％.术前心电图示ST-T改变及冠状动脉CT造影(CTA)显示,1枝以上血管狭窄(≥50％)在cTnI升高组及正常组之间差异有统计学意义(P＜0.05),并经Logistic回归分析证实,心电图ST-T改变OR值为2.807( 95％ CI=1.065～7.398,P=0.037),冠状动脉CTA示1枝以上狭窄OR值为11.579 (95％ CI=2.332 ～ 57.497,P=0.003).结论:术前心电图ST-T改变及冠状动脉CTA示1枝以上狭窄(≥50％)为腹主动脉瘤切除术后心脏损伤的预测因素.%Objective: To investigate the predictive factors associated with myocardial injury following open surgery for abdominal aortic aneurysm. Methods: The clinical data of 72 patients who underwent open surgery for abdominal aortic aneurysm were studied with the concerntration of cardiac troponin I ( cTnI) being measured preoperatively on the fore-and-aft operation. By comparing the clinical characteristics of the patients with elevated cTnI and normal cTnI, the predictive factors were obtained byx2 test and Logistic analysis. Results; Postoperatively, elevated cTnI was found in 30 of the 72 patients (41. 7% ). The predictive factors for cTnI elevation appeared associated with ECG change of ST-T and Coronary CTA displaying at least one stenosis ( ≥50% ) , which were different in statistics (P < 0. 05). Patients with elevated cTnI had an increased odds ratio for ECG change of ST-T (OR= 2. 807 [95% CI, 1. 065 to 7. 398] ,P =0. 037) and Coronary CTA (OR = 11.579 [95% CI,2. 332 to 57.497] ,P = 0. 003). Conclusion: ECG change of ST-T and Coronary CTA displaying at least one stenosis( ≥50% ) were the predictive factors of myocardial injury following open surgery for abdominal aortic aneurysm.
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