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老年胆道疾病患者围手术期主要不良心脏事件监测指标的临界值

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases.

作者信息

Zhang Zong-Ming, Xie Xi-Yuan, Zhao Yue, Zhang Chong, Liu Zhuo, Liu Li-Min, Zhu Ming-Wen, Wan Bai-Jiang, Deng Hai, Tian Kun, Guo Zhen-Tian, Zhao Xi-Zhe

机构信息

Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China.

Department of Cardiology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China.

出版信息

World J Clin Cases. 2022 Jul 16;10(20):6865-6875. doi: 10.12998/wjcc.v10.i20.6865.

Abstract

BACKGROUND

Major adverse cardiac events (MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.

AIM

To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.

METHODS

The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.

RESULTS

In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-I (Hs-TnI), creatine kinase isoenzyme (CK-MB), myoglobin (MYO), B-type natriuretic peptide (BNP), and D-dimer (D-D) levels were significantly increased ( < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic (ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.

CONCLUSION

The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

摘要

背景

老年胆道疾病患者的主要不良心脏事件(MACE)是围手术期意外死亡的主要原因,但目前尚无广泛认可的围手术期心功能定量监测指标。

目的

探讨老年胆道疾病患者围手术期MACE监测指标的临界值。

方法

回顾性分析2016年5月至2021年4月我院208例老年胆道疾病患者的临床资料。根据围手术期是否发生MACE,将其分为MACE组和非MACE组。

结果

与非MACE组相比,MACE组术后并发症、死亡率、住院时间、高敏肌钙蛋白I(Hs-TnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、B型利钠肽(BNP)和D-二聚体(D-D)水平显著升高(<0.05)。多因素logistic回归显示,术后BNP和D-D是围手术期MACE的独立危险因素,其在受试者工作特征(ROC)曲线中的截断值分别为382.65 pg/mL和0.965 mg/L。

结论

术后BNP和D-D是围手术期MACE的独立危险因素,临界值分别为382.65 pg/mL和0.965 mg/L。因此,及时监测并有效维持围手术期心功能稳定对进一步提高老年胆道疾病患者围手术期安全性具有重要临床意义。

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