摘要
目的回顾性分析重症监护室(intensive care unit,ICU)非心脏手术患者发生围手术期心肌损伤(myocardial injury after non-cardiac surgery,MINS)的临床危险因素及预后情况。方法选取2020年1月至2023年12月复旦大学附属闵行医院重症医学科的手术后患者478例,按术后7天内是否发生心肌损伤分为MINS组(n=302)与正常组(n=176),比较两组患者临床资料特征的差异性,筛选出围手术期发生心肌损害的危险因素。以30天死亡为临床终点,分析MINS组患者死亡的危险因素。结果MINS组急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,ApacheⅡ)评分、冠心病、慢性肾脏病患病率均较正常组高,差异有统计学意义(P<0.05)。MINS组急诊手术占比、合并感染、围手术期低血压与正常组相比差异有统计学意义(P<0.05)。多因素Logistic回归分析显示慢性肾脏病、急诊手术、合并感染、术中术后低血压是MINS的危险因素。预后分析显示围手术期低血压是MINS患者30天死亡的危险因素。结论MINS与患者的基础疾病、手术时机、围手术期低血压状态等密切相关,特别是围手术期低血压影响最终结局。
Objective To retrospectively analyze the clinical risk factors and prognosis of perioperative myocardial injury(MINS)in non-cardiac surgery patients admitted to the intensive care unit(ICU).Methods A total of 478 postoperative patients admitted to the Department of Intensive Medicine,Minhang Hospital,Fudan University from Jan 2020 to Dec 2023 were selected.They were divided into MINS group(n=302)and normal group(n=176)based on whether myocardial injury occurred within 7 days after surgery.The differences in clinical characteristics between the two groups were compared,and risk factors for perioperative myocardial injury were identified.Risk factors for mortality in the MINS group were analyzed with 30-day mortality as the clinical endpoint.Results The prevalence of acute physiology and chronic health evaluation Ⅱ(Apache Ⅱ)score,coronary artery disease,and chronic kidney disease were all higher in the MINS group than those in the normal group,with statistically significant differences(P<0.05).The proportion of emergency surgeries,co-infection,and perioperative hypotension were significantly different between the MINS group and the normal group(P<0.05).Multivariate logistic regression analysis revealed that chronic kidney disease,emergency surgery,coinfection,and intraoperative and postoperative hypotension were risk factors for MINS occurrence.Prognostic analysis indicated that perioperative hypotension was a risk factor for 30-day mortality in MINS patients.Conclusion MINS is closely associated with patients’underlying conditions,timing of surgery,and perioperative hypotension status,and especially perioperative hypotension affects the final outcomes.
作者
夏世宏
马雪丽
沈国锋
姜丽静
刘康溢
唐唯一
倪金迪
李响
XIA Shi-hong;MA Xue-li;SHEN Guo-feng;JIANG Li-jing;LIU Kang-yi;TANG Wei-yi;NI Jin-di;LI Xiang(Department of Intensive Medicine,Minhang Hospital,Fudan University,Shanghai 201199,China)
出处
《复旦学报(医学版)》
北大核心
2025年第3期424-428,445,共6页
Fudan University Journal of Medical Sciences
基金
国家临床重点专科建设项目(Z155080000004)。
关键词
心肌损伤
非心脏手术
围手术期
危险因素
myocardial injury
non-cardiac surgery
perioperative period
risk factors
