Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
Department of Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.
Aging Clin Exp Res. 2018 Oct;30(10):1217-1223. doi: 10.1007/s40520-018-0908-y. Epub 2018 Feb 12.
The development of sensitive myocardial-specific cardiac biomarkers allows for detection of very small amounts of myocardial injury or necrosis. Myocardial injury (MI) as a prelude of the serious perioperative complication myocardial infarction, should be paid more attention, especially in elderly susceptible patients. Myocardial injury after abdominal surgery in elderly patients has not been described yet. The objectives of this study were to identify the incidence, predictors, characteristics and the impact of MI on outcome in elderly patients underwent abdominal surgery.
Patients aged ≥ 65 who underwent abdominal surgery longer than 2 h between January 2016 and March 2017 were reviewed. Patients with peak troponin I level of 0.04 ng/ml or greater (abnormal laboratory threshold) within once-administration-period and without non-ischemia troponin elevation proof (e.g., sepsis) were assessed for characteristics and prognosis. Risk factors of MI were determined by multivariable regression.
Among 285 patients with whole information, 36 patients (12.6%) suffered MI, only 2 patients (0.7%) fulfilled definition of myocardial infarction. With most of them occurred within first 7 days after surgery. Multivariable analysis showed that coronary artery disease (CAD) history [odds ratio (OR) 2.817, P = 0.015], non-laparoscopic surgery (OR 5.181, P = 0.030), blood loss ≥ 800 ml (OR 3.430, P = 0.008), non-venous maintain (OR 2.105, P = 0.047), and infection (OR 4.887, P = 0.008) as risk factors for MI. MI was associated with longer hospital stay (P = 0.006), more cardiac consultation (P = 0.011), higher infection(P = 0.016) and reoperation(P = 0.026) rate.
MI is common in elderly patients who underwent abdominal surgery, while myocardial infarction is infrequent. They are both associated with risk factors and worse prognosis. MI deserves more attention especially in elderly patients. Troponin I measurement is a useful test after massive surgery, which can help risk-stratifying patients, effective preventing, prompt managing and predicting outcomes. Routine monitoring of cardiac biomarkers especially within 7 days after abdominal surgery in elderly patients is recommended.
敏感的心肌特异性心脏生物标志物的发展允许检测到非常小量的心肌损伤或坏死。心肌损伤（MI）作为严重围手术期并发症心肌梗死的前奏，应引起更多关注，尤其是在易受影响的老年患者中。尚未描述老年患者腹部手术后的心肌损伤。本研究的目的是确定腹部手术后老年患者 MI 的发生率、预测因素、特征以及对结果的影响。
回顾 2016 年 1 月至 2017 年 3 月期间接受腹部手术时间超过 2 小时的年龄 ≥ 65 岁的患者。在单次给药期内肌钙蛋白 I 峰值水平为 0.04ng/ml 或更高（异常实验室阈值）且无非缺血性肌钙蛋白升高证据（例如，脓毒症）的患者评估其特征和预后。通过多变量回归确定 MI 的危险因素。
在 285 名具有完整信息的患者中，36 名患者（12.6%）发生 MI，仅有 2 名患者（0.7%）符合心肌梗死的定义。其中大多数发生在手术后的前 7 天内。多变量分析显示，冠心病（CAD）病史[比值比（OR）2.817，P = 0.015]、非腹腔镜手术（OR 5.181，P = 0.030）、出血量 ≥ 800ml（OR 3.430，P = 0.008）、非静脉维持（OR 2.105，P = 0.047）和感染（OR 4.887，P = 0.008）是 MI 的危险因素。MI 与住院时间延长（P = 0.006）、更多的心脏咨询（P = 0.011）、更高的感染率（P = 0.016）和再次手术率（P = 0.026）相关。
MI 在接受腹部手术的老年患者中很常见，而心肌梗死则不常见。它们都与危险因素和预后不良相关。MI 尤其在老年患者中应引起更多关注。肌钙蛋白 I 测量是大手术后的一项有用检测，可以帮助对患者进行风险分层，有效预防、及时管理和预测结局。建议常规监测老年患者腹部手术后 7 天内的心脏生物标志物。
