Hartmann Bernd, Junger Axel, Röhrig Rainer, Klasen Joachim, Jost Andreas, Benson Matthias, Braun Helge, Fuchs Carsten, Hempelmann Gunter
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392 Giessen, Germany.
Langenbecks Arch Surg. 2003 Sep;388(4):255-60. doi: 10.1007/s00423-003-0398-y. Epub 2003 Aug 14.
Intra-operative tachycardia is a common adverse event, often recorded as an indicator for process quality in quality assurance projects in anaesthesia.
This retrospective study is based on data sets of 28,065 patients recorded with a computerised anaesthesia record-keeping system from 23 February 1999 to 31 December 2000 at a tertiary care university hospital. Cases were defined as patients with intra-operative tachycardia; references were automatically selected according to matching variables (high-risk surgery, severe congestive heart failure, severe coronary artery disease, significant carotid artery stenosis and/or history of stroke, renal failure, diabetes mellitus and urgency of surgery) in a stepwise fashion. Main outcome measures were hospital mortality, admission to the intensive care unit (ICU) and prolonged hospital stay. Differences in outcome measures between the matched pairs were assessed by univariate analysis. Stepwise regression models were developed to predict the impact of intra-operative tachycardia on the different outcome measures.
In our study 474 patients (1.7%) were found to have had intra-operative tachycardia. Matching was successful for 99.4% of the cases, leading to 471 cases and references. The crude mortality rates for the cases and matched references were 5.5% and 2.5%, respectively (P=0.020). Of all case patients, 22.3% were treated in an ICU, compared to 11.0% of the matched references (P=0.001). Hospital stay was prolonged in 25.1% of the patients with tachycardia compared to 15.1% of the matched references (P=0.001).
In this study, patients with intra-operative tachycardia who were undergoing non-cardiac surgery had a greater peri-operative risk, leading to increased mortality, greater frequency of admission to an ICU and prolonged hospital stay.
术中心动过速是一种常见的不良事件，在麻醉质量保证项目中常被记录为过程质量指标。
这项回顾性研究基于1999年2月23日至2000年12月31日在一家三级大学附属医院使用计算机化麻醉记录系统记录的28,065例患者的数据集。病例定义为术中出现心动过速的患者；对照根据匹配变量（高风险手术、严重充血性心力衰竭、严重冠状动脉疾病、严重颈动脉狭窄和/或中风病史、肾衰竭、糖尿病和手术紧急程度）逐步自动选择。主要结局指标为医院死亡率、入住重症监护病房（ICU）和住院时间延长。通过单因素分析评估匹配对之间结局指标的差异。建立逐步回归模型以预测术中心动过速对不同结局指标的影响。
在我们的研究中，发现474例患者（1.7%）术中出现心动过速。99.4%的病例匹配成功，产生了471例病例和对照。病例组和匹配对照组的粗死亡率分别为5.5%和2.5%（P=0.020）。所有病例患者中，22.3%在ICU接受治疗，而匹配对照组为11.0%（P=0.001）。心动过速患者中有25.1%住院时间延长，而匹配对照组为15.1%（P=0.001）。
在本研究中，接受非心脏手术的术中心动过速患者围手术期风险更高，导致死亡率增加、入住ICU的频率更高和住院时间延长。
