非心脏手术男性患者围手术期心肌缺血与心脏发病率和死亡率的关联。围手术期缺血研究组。

Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group.

作者信息

Mangano D T, Browner W S, Hollenberg M, London M J, Tubau J F, Tateo I M

机构信息

Department of Anesthesia, University of California, San Francisco.

出版信息

N Engl J Med. 1990 Dec 27;323(26):1781-8. doi: 10.1056/NEJM199012273232601.

DOI:10.1056/NEJM199012273232601

PMID:2247116

Abstract

BACKGROUND

Adverse cardiac events are a major cause of morbidity and mortality after noncardiac surgery. It is necessary to determine the predictors of these outcomes in order to focus efforts on prevention and treatment. Patients undergoing noncardiac surgery sometimes have postoperative cardiac events. It would be helpful to know which patients are at highest risk.

METHODS

We prospectively studied 474 men with coronary artery disease (243) or at high risk for it (231) who were undergoing elective noncardiac surgery. We gathered historical, clinical, laboratory, and physiologic data during hospitalization and for 6 to 24 months after surgery. Myocardial ischemia was assessed by continuous electrocardiographic monitoring, beginning two days before surgery and continuing for two days after.

RESULTS

Eighty-three patients (18 percent) had postoperative cardiac events in the hospital that were classified as ischemic events (cardiac death, myocardial infarction, or unstable angina) (15 patients), congestive heart failure (30), or ventricular tachycardia (38). Postoperative myocardial ischemia occurred in 41 percent of the monitored patients and was associated with a 2.8-fold increase in the odds of all adverse cardiac outcomes (95 percent confidence interval, 1.6 to 4.9; P less than 0.0002) and a 9.2-fold increase in the odds of an ischemic event (95 percent confidence interval, 2.0 to 42.0; P less than 0.004). Multivariate analysis showed no other clinical, historical, or perioperative variable to be independently associated with ischemic events, including cardiac-risk index, a history of previous myocardial infarction or congestive heart failure, or the occurrence of ischemia before or during surgery.

CONCLUSIONS

In high-risk patients undergoing noncardiac surgery, early postoperative myocardial ischemia is an important correlate of adverse cardiac outcomes.

摘要

背景

心脏不良事件是非心脏手术术后发病和死亡的主要原因。确定这些结果的预测因素对于集中精力进行预防和治疗很有必要。接受非心脏手术的患者有时会发生术后心脏事件。了解哪些患者风险最高会有所帮助。

方法

我们前瞻性地研究了474例患有冠状动脉疾病（243例）或有高风险（231例）且正在接受择期非心脏手术的男性。我们收集了住院期间以及术后6至24个月的病史、临床、实验室和生理数据。从手术前两天开始并持续至术后两天，通过连续心电图监测评估心肌缺血情况。

结果

83例患者（18%）在医院发生了术后心脏事件，这些事件被分类为缺血性事件（心源性死亡、心肌梗死或不稳定型心绞痛）（15例）、充血性心力衰竭（30例）或室性心动过速（38例）。41%的受监测患者发生了术后心肌缺血，这与所有心脏不良结局的几率增加2.8倍相关（95%置信区间，1.6至4.9；P<0.0002），与缺血性事件的几率增加9.2倍相关（95%置信区间，2.0至42.0；P<0.004）。多变量分析显示，没有其他临床、病史或围手术期变量与缺血性事件独立相关，包括心脏风险指数、既往心肌梗死或充血性心力衰竭病史，或手术前或手术期间的缺血发生情况。