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术前超声心动图检查异常与非心脏手术患者术后主要不良心脏事件的关系:一项巢式病例对照研究
作者:李春晶 郭超 王博杰 穆东亮 王东信 
单位:100034  北京  北京大学第一医院麻醉与重症医学科(李春晶、郭超、王博杰、穆东亮、王东信) 
关键词:超声心动描记术 主要心脏不良事件 病例对照研究 
分类号:R619+.9
出版年,卷(期):页码:2018,43(2):158-165
摘要:

[摘要]  目的 探讨非心脏手术患者术前经胸超声心动图(TTE)检查异常与术后主要心脏不良事件(MACE)之间的关系。方法  采用巢式病例对照研究的方法,以201211月-20131月在北京大学第一医院接受择期非心脏手术的患者作为研究对象,通过复习电子病例筛选术前接受TTE检查的患者,主要观察指标是术后MACE发生率,以是否发生MACE将患者分为MACE组和对照组。按照4:1的比例为MACE组患者选择匹配病例,对照组筛选标准为:与MACE组的改良心脏风险评分和手术类型相同。收集两组患者的基本资料和围术期相关资料,采用多因素回归分析筛选与MACE相关的危险因素。结果 研究期间共2975例患者接受了择期手术,2081例患者符合入组要求,其中530例患者接受了术前TTE检查,25例患者出现了术后MACETTE异常的整体发生率为91.9%(487/530)。通过病例匹配,25例入组MACE组,100例入组对照组。MACE组和对照组TTE异常的发生率分别为92.0%(23/25)93.0%(93/100),组间比较差异无统计学意义(OR=0.86695%CI 0.169~4.446P=1.000)。多因素回归分析显示,左室肥厚是术后MACE的独立危险因素之一(OR=4.32495%CI 1.320~14.160P=0.016),其他危险因素还包括女性(OR=4.78295%CI 1.636~13.980P=0.005)和慢性肾衰竭(OR=21.95295%CI 1.547~311.475P=0.016)。受试者工作特征曲线分析显示,术前TTE整体异常对于术后MACE的预测价值很低(曲线下面积为0.501P=0.992)结论 左室肥厚是术后MACE的独立危险因素之一,但是术前是否须常规行TTE检查仍需要进一步研究证实。

[Abstract]  Objective To investigate the relationship between preoperative abnormal transthoracic echocardiogram (TTE) and postoperative major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery. Methods  This study was a nested case control study. Patients who underwent elective non-cardiac surgery in Peking University First Hospital from November 15, 2012 to January 15, 2013 were enrolled. We screened patients who received preoperative TTE examination from electrical medical record. The primary outcome of this study was the incidence of postoperative MACEs. The patients were divided into MACE group and control group depending on if they suffered MACE. For each patient in MACE group, 4 patients without MACE events were selected for control group in term of two criteria: same revised cardiac risk index and same type of surgery. Related perioperative data were collected. Multivariate logistic analysis was used for screening potential risk factors related to MACE. Results  During the study period, a total of 2975 patients undergoing elective surgery, 2081 met the inclusion criteria. Amongst these patients, 530 patients received preoperative TTE examinations and 25 suffered postoperative MACEs. Overall incidence of TTE abnormalities was 91.9%(487/530). 25 patients with MACE and 100 patients without MACE (as control group) were selected for case control analysis. The incidence of TTE abnormality was about 92.0% (23/25) in MACE group and 93.0%(93/100) in control group (OR=0.866, 95%CI 0.169-4.446, P=1.000). Multivariate logistic analysis showed that left ventricular hypertrophy was an independent risk of MACE (OR=4.324, 95%CI 1.320-14.160, P=0.016), female(OR=4.782, 95%CI 1.636-13.980, P=0.005) and history of chronic renal failure (OR=21.952, 95%CI 1.547-311.475, P=0.016) were also related with MACE. The predictive value of preoperative TTE abnormality against MACE was very low in ROC analysis (AUC=0.501, P=0.992). Conclusions  Left ventricular hypertrophy is related to increased risk of postoperative MACE. However, further studies are needed to confirm the value of TTE examination as a routine examination for cardiac evaluation before surgery.

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