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Risk Factors for Myocardial Injury in Critical Care Patients after Abdominal Surgery
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摘要:
目的 探讨腹腔手术后重症患者心肌损伤的发生情况及可能的危险因素。 方法 回顾性分析北京大学人民医院2017年1月至2019年1月腹腔手术后重症患者的一般临床资料及心肌损伤情况，收集并观察基础病史、术中(手术时间、是否急诊手术、术中出血＞800 ml和术中低血压等)及术后指标(改良氧合指数、血乳酸、急性肾损伤和术后24 h内使用升压药情况等)。根据术后是否发生心肌损伤，将患者分为心肌损伤组和非心肌损伤组，采用Logistic回归分析腹腔手术后重症患者心肌损伤的危险因素。 结果 在纳入的803例腹腔手术后重症患者中，心肌损伤发生率为17.2%(138/803)，而急性心肌梗死发生率仅为0.9%(7/803)。单因素分析显示，慢性肾功能不全病史、手术时间、急诊手术、术中低血压、术后24 h内使用升压药、高APACHEⅡ评分及术后即刻急性肾损伤与术后重症患者心肌损伤相关(P＜0.05)。多因素回归分析显示，急诊手术(OR=3.14，95% CI：1.76~5.60，P＜0.001)、术后24 h内使用升压药(OR=2.26，95% CI：1.23~4.15，P=0.008)、APACHEⅡ评分(OR=1.05，95% CI：1.01~1.09，P=0.008)和术后急性肾损伤(OR=3.18，95% CI：1.78~5.69，P＜0.001)与腹腔手术后重症患者发生心肌损伤独立相关。 结论 重症患者腹腔手术后心肌损伤发生率高，急诊手术、术后24 h内使用升压药、高APACHEⅡ评分和术后急性肾损伤是导致腹腔手术后重症患者发生心肌损伤的独立危险因素。 Abstract:Objective The aim of this study was to investigate the incidence and the possible risk factors for myocardial injury in critical care patients after abdominal surgery. Methods A retrospective study of critical care patients after abdominal surgery from January 2017 to January 2019 in Peking University People's Hospital was carried out. General clinical data and myocardial injury after abdominal surgery were analyzed. The clinical data including medical history, intraoperative conditions (operational time, emergency surgery, intraoperative hemorrhage, and intraoperative hypotension, etc), and postoperative conditions (modified oxygenation index, blood lactic acid, acute kidney injury, vasopressor drugs used within 24h after operation) were observed. According to whether myocardial injury occurred after abdominal surgery, patients were divided into the myocardial injury group and the non-myocardial injury group. Risk factors for myocardial injury after abdominal surgery were analyzed using Logistic regression. Results The incidence of myocardial injury for critical care patients after abdominal surgery was 17.2%(138/803), while the incidence of acute myocardial infarction was only 0.9%(7/803). There were 7 risk factors correlated with myocardial injury after abdominal surgery in critical patients by univariate analysis, including previous chronic kidney disease, operational time, emergency surgery, intraoperative hypotension, vasopressor drugs used within 24 h after operation, APACHE Ⅱ scores, and postoperative acute kidney injury; the independent risk factors for myocardial injury in these patients by Logistic regression analysis included emergency surgery (OR=3.14, 95% CI:1.76-5.60, P < 0.001), administration of vasopressor drugs within 24 h after the operation(OR=2.26, 95% CI:1.23-4.15, P=0.008), high APACHEⅡ scores(OR= 1.05, 95% CI:1.01-1.09, P=0.008), and postoperative acute kidney injury(OR=3.18, 95% CI:1.78-5.69, P < 0.001). Conclusions The incidence of myocardial injury in critical care patients after abdominal surgery is high. Emergency surgery, administration of vasopressor drugs within 24 h after the operation, high APACHEⅡ scores, and postoperative acute kidney injury are the independent risk factors associated with myocardial injury in critical care patients after abdominal surgery. -
Key words:
- abdominal surgery /
- myocardial injury /
- risk factor
利益冲突 无 -
表 1 803例腹腔手术后重症患者心肌损伤危险因素的单因素分析
危险因素 心肌损伤组(n=138) 非心肌损伤组(n=665) 检验值 P值 男性[n(%)] 75(54.3) 344(51.7) χ2=0.314 0.575 年龄(x±s，岁) 62.7±17.3 62.6±15.1 t=0.099 0.921 病史[n(%)] 冠心病 16(11.6) 87(13.1) χ2=0.226 0.634 高血压 56(40.6) 312(46.9) χ2=1.849 0.174 糖尿病 24(17.4) 106(15.9) χ2=0.177 0.674 慢性肾功能不全 10(7.2) 23(3.5) χ2=4.161 0.041 高危手术[n(%)] 47 (34.1) 243 (36.5) χ2=0.305 0.580 手术时间(x±s, h) 5.0±3.0 4.9±2.3 t=6.198 0.013 急诊手术[n(%)] 26(18.8) 37(5.6) χ2=27.789 < 0.001 术中出血 > 800 ml [n(%)] 47(34.1) 204(31.0) χ2=0.590 0.443 术中低血压[n(%)] 49(35.8) 165(25.0) χ2=6.641 0.010 术后即刻pO2/FiO2 [M(QR), mm Hg] 310.3 (217.4, 398.4) 330.6 (239.0, 413.5) U=0.989 0.323 术后即刻Hb < 80 g/L [n(%)] 11 (8.0) 46 (7.0) χ2=0.221 0.638 术后即刻乳酸 > 4 mmol/L [n(%)] 12 (8.7) 85 (12.9) χ2=1.846 0.174 术后急性肾损伤[n(%)] 23(16.7) 38(5.7) χ2=19.530 < 0.001 术后24 h内使用升压药[n(%)] 17(12.4) 40(6.0) χ2=7.034 0.008 术后24 h内APACHEⅡ评分(x±s) 16.3±5.9 14.5±4.3 t=13.421 < 0.001 
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表 2 803例腹腔手术后重症患者心肌损伤危险因素的多因素分析
危险因素 P值 Wald值 OR 95% CI 急诊手术 < 0.001 15.099 3.14 1.76~5.60 术后24 h内使用升压药 0.008 6.950 2.26 1.23~4.15 高APACHEⅡ评分 0.008 6.948 1.05 1.01~1.09 术后急性肾损伤 < 0.001 15.234 3.18 1.78~5.69
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