摘要
目的 探讨脊柱手术围手术期心血管并发症的发生率和危险因素.方法 选择2015 年 1 月～2020 年 12 月在该院接受全身麻醉下脊柱手术的 1508 例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、血红蛋白(haemoglobin,Hb)、内生肌酐清除率(endogenous creatinine clearance rate,Ccr)、伴随疾病、手术原因、手术状态、手术方式、融合节段、术中事件、手术医师等等资料,观察围手术期(本研究定义为患者住院期间及术后28d内)发生的主要心血管不良事件(major adverse cardiovascular events,MACE)发生率.根据是否发生MACE将患者分为两组,采用单因素(卡方检验、t检验)和多因素分析观察影响MACE的风险因素.结果 本研究中,共22 例患者在研究定义的时间内发生MACE,发生率 1.46%.单因素分析显示,MACE和非MACE患者的BMI、Hb、高血压、中风、阻塞性睡眠呼吸暂停、甲状腺疾病、慢性肺疾病、手术状态、手术方式、术中高血压等资料比较,差异均无统计学意义(P＞0.05);MACE和非MACE患者的性别、年龄、ASA分级、Ccr、糖尿病、慢性肾脏疾病、慢性心力衰竭、手术原因、融合节段、术中低血压、术中输血等资料比较,差异均存在统计学意义(P＜0.05).多因素Logistic分析结果显示,手术原因为脊柱侧凸、术前有慢性心力衰竭史、术中发生低血压均是影响术后MACE的风险因素(P＜0.05).结论 脊柱手术患者围手术期MACE发生率为 1.45%,影响MACE发生的风险因素可能包括术前慢性心力衰竭史、脊柱侧凸手术和术中低血压.
Abstract
Objective To investigate the incidence and risk factors of perioperative cardiovascular complications in spinal surgery.Methods A total of 1508 patients who received spinal surgery under general anesthesia in our hospital from January 2015 to December 2020 were selected as the study subjects.The patients'sex,age,body mass index(BMI),American society of anesthesiologists(ASA)classification,hemoglobin(Hb),endogenous creatinine clearance rate(Ccr),concomitant diseases,surgical reasons,surgi-cal status,surgical methods,fusion segments,intraoperative events,and their surgeons were recorded.The incidence of major adverse cardiovascular events(MACE)during perioperative period(defined as hospitalization and 28 days after surgery in this study)was ob-served.Patients were divided into two groups according to whether MACE occurred.Single factor(chi square test,t-test)and multiva-riate analysis were used to observe the risk factors affecting MACE.Results A total of 22 patients had MACE within the time defined in the study,with an incidence of 1.46%.Univariate analysis showed that there was no significant difference in body mass index,Hb,hypertension,stroke,obstructive sleep apnea,thyroid disease,chronic disease,surgical status,surgical methods,and intraoperative hypertension between MACE and non MACE patients(P＞0.05),and there were statistically significant differences between mace and non mace patients in gender,age,ASA grade,CCR,diabetes,chronic kidney disease,chronic heart failure,surgical cause,fusion segment,intraoperative hypotension,intraoperative blood transfusion,etc.(P＜0.05).Multivariate logistic analysis showed that scol-iosis,preoperative history of chronic heart failure,and intraoperative hypotension were risk factors for postoperative MACE(P＜0.05).Conclusion The incidence of perioperative MACE in patients undergoing spinal surgery is 1.45%.The risk factors affecting the occurrence of MACE may include preoperative CHF history,scoliosis surgery and intraoperative hypotension.
维普
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