目的:探讨远端缺血预处理(remote ischemic preconditioning，RIPC)对髋部骨折老年患者术后1年发生心血管不良事件(major adverse cardiovascular events，MACEs)的影响。方法:2015年4月至2020年5月经手术治疗髋部骨折老年患者314例，男116例，女198例;年龄60～76岁;均为美国麻醉医师协会(American Society of Anesthesiolo-gists，ASA)Ⅱ-Ⅲ级。所有患者进行常规麻醉，根据是否进行RIPC将患者分为两组，157例在常规麻醉基础上应用RIPC为干预组，男56例，女101例，年龄(68。12±7。13)岁;另157例为对照组，男60例，女97例，年龄(68。24±7。05)岁。对比分析两组患者术后1年的MACEs事件。结果:应用RIPC髋部骨折患者术后1年发生心肌梗死、心力衰竭、脑卒中、非致命性心搏停止、冠状动脉血运重建术、严重心律失常、周围动脉血栓形成、心血管疾病再住院、术后1年全因死亡影响的 OR值分别是 1。269、1。304、0。977、1。089、1。315、1。335、0。896、0。774、1。191，但差异均无统计学意义(P＞0。05)。结论:髋部骨折术后1年内，RIPC并未明显影响改变主要心血管不良事件的发生。非心脏手术中RIPC对临床心血管结局的长期影响需要在适当的随机临床试验中得到证实。
Effect of distal ischemic preconditioning on cardiovascular events in adult patients with hip fracture one year after operation
Objective To investigate the effect of remote ischemic preconditioning(RIPC)on major adverse cardiovascu-lar events(MACE)in elderly patients with hip fracture 1 year after operation.Methods Total of 314 elderly patients with hip fracture of grade Ⅱ and Ⅲ for American Society of Anesthesiologists(ASA)were treated by surgical operation from April 2015 to May 2020 including 116 males and 198 females,the age ranged from 60 to 76 years old.The subjects were divided into in-tervention group and control group according to whether received RIPC.Among them,157 cases in intervention group included 56 males and 101 females with an average age of(68.12±7.13)years old and 157 cases in control group included 60 males and 97 females with an average age of(68.24±7.05)years old.Both groups were given routine anesthesia.The intervention group was treated with RIPC on the basis of routine anesthesia.The MACE events 1 year after operation in two groups were com-pared and analyzed.Results The OR values of RIPC for myocardial infarction,heart failure,stroke,nonfatal cardiac arrest,coronary revascularization,severe arrhythmia,peripheral artery thrombosis,readmission of cardiovascular disease,and all-cause death in patients with hip fracture one year after operation were 1.269,1.304,0.977,1.089,1.315,1.335,0.896,0.774,1.191,respectively,but there was no significant difference(P＞0.05).Conclusion RIPC did not significantly affect and change the occurrence of major cardiovascular adverse events within 1 year after hip fracture surgery.The long term impact of RIPC on clinical cardiovascular outcomes in non cardiac surgery needs to be confirmed in appropriate randomized clinical trials.
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