腹腔手术后重症患者心肌损伤的危险因素

赵秀娟, 朱凤雪, 李纾, 周刚, 安友仲

赵秀娟, 朱凤雪, 李纾, 周刚, 安友仲. 腹腔手术后重症患者心肌损伤的危险因素[J]. 协和医学杂志, 2019, 10(4): 342-346. DOI: 10.3969/j.issn.1674-9081.2019.04.006
引用本文: 赵秀娟, 朱凤雪, 李纾, 周刚, 安友仲. 腹腔手术后重症患者心肌损伤的危险因素[J]. 协和医学杂志, 2019, 10(4): 342-346. DOI: 10.3969/j.issn.1674-9081.2019.04.006
Xiu-juan ZHAO, Feng-xue ZHU, Shu LI, Gang ZHOU, You-zhong AN. Risk Factors for Myocardial Injury in Critical Care Patients after Abdominal Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(4): 342-346. DOI: 10.3969/j.issn.1674-9081.2019.04.006
Citation: Xiu-juan ZHAO, Feng-xue ZHU, Shu LI, Gang ZHOU, You-zhong AN. Risk Factors for Myocardial Injury in Critical Care Patients after Abdominal Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(4): 342-346. DOI: 10.3969/j.issn.1674-9081.2019.04.006

腹腔手术后重症患者心肌损伤的危险因素

基金项目: 

国家临床重点专科建设基金项目 2010

详细信息
    通讯作者:

    安友仲电话:010-88324480,E-mail:bjicu@163.com

  • 中图分类号: R459.7;R619+.9

Risk Factors for Myocardial Injury in Critical Care Patients after Abdominal Surgery

More Information
    Corresponding author:

    You-zhong AN: AN You-zhong Tel: 86-10-88324480, E-mail: bjicu@163.com

  • 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.
  • 腹腔手术并发症显著影响患者的术后康复。心脏事件是非心脏手术后死亡的主要原因,其中心肌梗死是常见并发症,发生率为1%~7%[1-4]。非心脏手术后心肌损伤[5]是近年提出的新概念,范围由原来的心肌梗死扩展至心肌损伤,临床常见,与术后30 d和1年死亡率相关[5-6]。非心脏手术后心肌损伤的发生率为8%~22%,其中仅15.8%的患者出现心肌缺血的症状[5-6]。心肌损伤可通过检测心肌肌钙蛋白I(cardiac troponin I,cTNI)来确定[5],cTNI和cTNT均是诊断心肌梗死的生物标志物,国内检测cTNI的敏感度较cTNT高[7]。目前关于腹腔手术后心肌损伤的研究尚少,本研究主要探讨腹腔手术后重症患者心肌损伤的发生情况及其可能的危险因素。

    2017年1月至2019年1月在北京大学人民医院接受腹腔手术后转入重症医学科的连续性重症患者入组本研究,回顾性收集并分析患者相关临床资料。

    入选标准:(1)年龄 > 18岁;(2)接受腹腔手术,包括胃、十二指肠、小肠、结直肠、肝胆胰手术;(3)急性生理和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ) > 8分。

    排除标准:(1)妊娠妇女;(2)非缺血原因导致的cTNI升高(如感染、肺栓塞或心肺复苏术后);(3)心力衰竭(纽约心脏病协会分级Ⅲ级和Ⅳ级)。

    分组: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,综合分析与心肌损伤相关的危险因素。

    一般指标包括性别, 年龄,既往高血压、冠状动脉粥样硬化性心脏病(冠心病)、糖尿病及慢性肾功能不全病史,手术风险(是否高危)[1],是否急诊手术,手术时间,术中出血量 > 800 ml及低血压情况,术后改良氧合指数(氧分压/氧浓度,partial oxygen pressure/fraction of inspired oxygen,pO2/FiO2)、血红蛋白、血乳酸,术后急性肾损伤[定义为48 h内血肌酐增高 > 0.3 mg/dl或血肌酐增高至基础值的1.5倍以上,确认或估测7 d内发生;或尿量 < 0.5 ml/(kg·h)超过6 h][8],术后24 h内升压药物使用情况及APACHEⅡ评分。

    主要指标为腹腔手术后48 h内由心肌缺血(而非心肌坏死)导致的心肌损伤发生情况[5],当cTNI > 0.034 ng/ml时可判定存在心肌损伤[9-11],本研究监测术后即刻、术后24 h及48 h的血清cTNI水平(Beckman Coulter, Inc., 美国)。

    使用SPSS 22.0统计软件进行分析。符合正态分布的计量资料结果以均数±标准差表示,两组间比较采用样本独立t检验;非正态分布的计量资料结果以中位数(四分位间距)表示,分析采用非参数Mann-Whitney U检验。计数资料结果以百分数表示,组间比较采用χ2检验或Fisher's精确概率法。采用多元非条件Logistic回归分析心肌损伤的危险因素。P < 0.05为差异有统计学意义。

    共803例符合入选和排除标准的连续术后重症患者纳入本研究,其中男性419例(52.2%,419/803),女性384例(47.8%,384/803),平均年龄(62.6±15.5)岁,APACHEⅡ评分(14.8±4.7)分。既往有冠心病史者103例(12.8%,103/803)、高血压病史368例(45.8%,368/803)、糖尿病病史130例(16.2%,130/803)、慢性肾功能不全病史33例(4.1%,33/803);高危手术290例(36.1%,290/803),急诊手术63例(7.8%,63/803);手术时间为(4.9±2.4)h,术中出血量400 (100,1000) ml;术中214例发生低血压(26.7%,214/803),61例出现急性肾损伤(7.6%,61/803),57例患者在术后24 h内使用升压药(7.1%,57/803);术后pO2/FiO2为327.8 (237.2,410.5) mm Hg,血红蛋白110 (96,124) g/L,乳酸1.4 (0.9,2.6) mmol/L。

    术后138例患者cTNI升高(> 0.034 ng/ml),心肌损伤发生率为17.2%(138/803),其中约2/3为即刻升高(60.1%,83/138),术后24 h cTNI > 0.034 ng/ml者有89例(64.5%,89/138),术后48 h cTNI > 0.034 ng/ml者为54例(39.1%,54/138),其中7例为急性心肌梗死(0.9%,7/803),10例出现院内全因死亡(7.2%,10/138)。

    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、APACHEⅡ评分及术后急性肾损伤情况与术后重症患者的心肌损伤有关(P < 0.05)(表 1)。

    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
    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
    下载: 导出CSV 
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    将单因素分析显示有统计学差异的变量带入多元非条件Logistic回归分析,提示急诊手术(OR=2.66,95% CI:1.37~5.19,P=0.004)、术后24 h内使用升压药(OR=2.06,95% CI:1.06~4.00,P= 0.032)、高APACHEⅡ评分(OR=1.05,95% CI:1.01~ 1.09,P=0.021)和术后即刻急性肾损伤(OR=3.26,95% CI:1.74~6.10,P < 0.001)为腹腔术后重症患者心肌损伤的危险因素(表 2)。

    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 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
    下载: 导出CSV 
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    本研究显示,腹腔手术后重症患者心肌损伤的发生率高,术后急性肾损伤、急诊手术、术后24 h内使用升压药和高APACHEⅡ评分与术后心肌损伤的发生相关。

    近年研究提示,围手术期患者多出现心肌损伤,但尚未达到心肌梗死的诊断标准,表现为术后cTNI轻度升高,通常缺乏心肌缺血症状,但术后1年和30 d的死亡率显著增加[5, 12-16]。VISON研究显示,非心脏手术后心肌损伤发生率为8%,心肌损伤是术后30 d死亡的独立危险因素,且与术后并发症相关[5]。Noordzij等[15]观察了重要腹腔手术后且有冠心病发病风险的203例患者,发现术后高敏肌钙蛋白T增加≥100%是术后30 d非心脏并发症的预测因素,且与住院时间及院内死亡率增加相关。另一项研究观察了285例老年患者腹部手术后心肌损伤的发生情况,发生率为12.6%,其中仅2例(0.7%,2/285)达到心肌梗死诊断标准,心肌损伤与住院时间、心脏并发症、感染及再次手术相关[16]。本研究结果显示,腹部手术后重症患者心肌损伤常见(17.2%),而心肌梗死则较少(0.9%),因此我们不仅要重视腹部手术后发生心肌梗死的患者,更要关注心肌损伤的发生。本研究提示,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腹部手术后重症患者心肌损伤的危险因素,通过识别上述危险因素,可以帮助医生早期识别,开展个体化评估,尽早采取适宜的干预措施。有研究显示,非心脏手术患者慢性肾脏病与主要不良心脏及脑血管事件相关[17],术前肾功能不全会增加心肌梗死的发生率[18],而急性肾损伤是重症患者非心脏术后心肌损伤的独立危险因素[19]。本研究中术后急性肾损伤与腹部手术后重症患者心肌损伤独立相关,腹部手术后急性肾损伤的心肌损伤风险是非急性肾损伤患者的3倍余,提示需重视急性肾损伤发生的可能,即使血肌酐轻度升高,仍需密切监测肾功能变化,及时调整治疗方案。一项纳入46 799例非心脏手术患者的单中心回顾性研究显示,手术Apgar评分、急诊手术、术中心动过速和低血压与围术期心肌梗死独立相关[20],另一项观察严重主动脉狭窄患者接受非心脏手术风险的研究显示,急诊手术是该类患者30 d死亡率的最强预测因素[21]。本研究中急诊手术患者腹部手术后心肌损伤的风险是非急诊手术的2倍多,可能的原因有以下两方面:(1)急诊手术患者术前心血管评估和准备不足;(2)急诊手术通常为高危手术,常伴随严重和复杂的合并症或并发症,如合并急腹症较多,本研究中37.5%的患者合并急腹症,且术中低血压、低容量、心律失常更多见。有研究提示,术中低血压与术后心肌梗死及死亡相关[22-23],本研究中术后24 h内使用升压药是心肌损伤的独立危险因素,与上述结论相符。术后24 h内使用升压药提示患者存在明显低血压,而低血压导致的心肌缺血可明显增加心脏事件,且升压药本身会增加心肌氧耗,故术后心肌损伤发生的风险随之增加。

    本研究存在一定的局限性。首先,单中心回顾性研究存在未测量的混杂因素;其次,既往研究提示手术后心肌损伤主要发生在术后3 d之内[9-11],由于多数患者术后48 h已转回普通病房,而普通病房无法常规监测cTNI,仅36.8%的患者具备术后72 h cTNI数据,导致该指标缺失较多,故本研究仅观察了术后48 h内的cTNI水平,未收集术后72 h数据,由此可能会漏检部分心肌损伤病例,导致结果低估;最后,因仅42%的患者有超声心动图数据,故未收集分析该指标,避免结果偏倚。

    腹部手术后重症患者心肌损伤常见,表现隐匿,预后较差,需高度重视,应加强围手术期管理,推荐术后常规监测心肌损伤,及早识别,采取预防和治疗措施,以减少手术后心肌损伤的发生和危害。未来需进一步开展更多临床研究,建立预防和降低腹部术后心肌损伤的综合防控策略。

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  • 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
    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
    下载: 导出CSV

    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 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
    下载: 导出CSV
  • [1]

    Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non cardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [J]. Circulation, 2014, 130: e278-e333. https://www.ncbi.nlm.nih.gov/pubmed/25523415

    [2]

    Ollila A, Vikatmaa L, Virolainen J, et al. Perioperative myocardial infarction in non-cardiac surgery patients: a prospective observational study [J]. Scand J Surg, 2017, 106: 180-186. https://www.ncbi.nlm.nih.gov/pubmed/27738245

    [3] 曲歌, 于春华, 黄宇光.非心脏手术围术期心肌缺血和心肌梗死[J].协和医学杂志, 2013, 4: 43-47. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xhyx201301013
    [4]

    Smilowitz NR, Gupta N, Guo Y, et al. Perioperative acute myocardial infarction associated with non-cardiac surgery [J]. Eur Heart J, 2017, 38: 2409-2417. https://academic.oup.com/eurheartj/article/38/31/2409/3896243

    [5]

    Botto F, Alonso-Coello P, Chan MT, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes [J]. Anesthesio-logy, 2014, 120: 564-578. https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917890

    [6]

    van Waes JA, Grobben RB, Nathoe HM, et al. One-year mortality, causes of death, and cardiac interventions in patients with postoperative myocardial injury [J]. Anesth Analg, 2016, 123: 29-37.

    [7] 卢丰才.肌钙蛋白I与肌钙蛋白T敏感性的比较和分析[J].医学检验与临床, 2010, 21: 41-43. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=qlyxjy201001017
    [8]

    Ad-hoc working group of ERBP, Fliser D, Laville M, Covic A, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: part 1: definitions, conservative management and contrast-induced nephropathy [J]. Nephrol Dial Transplant, 2012, 27: 4263-4272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520085/

    [9]

    Longhitano S, Coriat P, Agrò F. Postoperative myocardial infarction: pathophysiology, new diagnostic criteria, prevention [J]. Minerva Anestesiol, 2006, 72: 965-983. https://www.ncbi.nlm.nih.gov/pubmed/17235264

    [10]

    Le Manach Y, Perel A, Coriat P, et al. Early and delayed myocardial infarction after abdominal aortic surgery [J]. Anesthesiology, 2005, 102: 885-891. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW201705250129552

    [11]

    Martinez EA, Nass CM, Jermyn RM, et al. Intermittent cardiac troponin-I screening is an effective means of surveillance for a perioperative myocardial infarction [J]. J Cardiothorac Vasc Anesth, 2005, 19: 577-582. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=4a0e2d9e016ca19e64f71ce591d3a196

    [12]

    Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery [J]. J Am Coll Cardiol, 2003, 42: 1547-1554. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=7ae17b8d16194aeb1fdf1ff43af376ca

    [13]

    Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Devereaux PJ, Chan MT, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery [J]. JAMA, 2012, 307: 2295-2304. https://www.ncbi.nlm.nih.gov/pubmed/22706835

    [14]

    Levy M, Heels-Ansdell D, Hiralal R, et al. Prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurement after noncardiac surgery: a syste-matic review and meta-analysis [J]. Anesthesiology, 2011, 114: 796-806.

    [15]

    Noordzij PG, Van Geffen O, Dijkstra IM, et al. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery [J]. Br J Anaesth, 2015, 114: 909-918. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=7447dc9136d2ffaf9861bc7925226002

    [16]

    Huang S, Peng W, Yang N, et al. Myocardial injury in elderly patients after abdominal surgery [J]. Aging Clin Exp Res, 2018, 30: 1217-1223.

    [17]

    Sabaté S, Mases A, Guilera N, et al. Incidence and predictors of major perioperative adverse cardiac and cerebrova-scular events in non-cardiac surgery [J]. Br J Anaesth, 2011, 107: 879-890. http://www.onacademic.com/detail/journal_1000039416837510_b547.html

    [18]

    Causey MW, Maykel JA, Hatch Q, et al. Identifying risk factors for renal failure and myocardial infarction following colorectal surgery [J]. J Surg Res, 2011, 170: 32-37. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=78f2fc54648d9e2a18908b5145e2c177

    [19]

    Zhao XJ, Zhu FX, Li S, et al. Acute kidney injury is an independent risk factor for myocardial injury after noncardiac surgery in critical patients [J]. J Crit Care, 2017, 39: 225-231. https://www.sciencedirect.com/science/article/abs/pii/S0883944116303896

    [20]

    House LM, Marolen KN, St Jacques PJ, et al. Surgical Apgar score is associated with myocardial injury after noncardiac surgery [J]. J Clin Anesth, 2016, 34: 395-402. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=f55f3effda42ddd905f4b283dcaa2669

    [21]

    Tashiro T, Pislaru SV, Blustin JM, et al. Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practice [J]. Eur Heart J, 2014, 35: 2372-2381. https://www.researchgate.net/publication/260271376_Perioperative_risk_of_major_non-cardiac_surgery_in_patients_with_severe_aortic_stenosis_A_reappraisal_in_contemporary_practice

    [22]

    Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: A retrospective cohort analysis [J]. Anesthesiology, 2017, 126: 47-65. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=d5ff6a864632af4a9cd69af7055e3c44

    [23]

    Sessler DI, Meyhoff CS, Zimmerman NM, et al. Period-dependent associations between hypotension during and for four days after noncardiac surgery and a composite of myocardial infarction and death: A substudy of the POISE-2 Trial [J]. Anesthesiology, 2018, 128: 317-327. https://www.ncbi.nlm.nih.gov/pubmed/29189290

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  • 收稿日期:  2019-03-27
  • 刊出日期:  2019-09-29

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