Palcau Alexandru Cosmin, Paduraru Livia Florentina, Dinulescu Alexandru, Musat Florentina, Ion Daniel, Paduraru Dan Nicolae, Iliesiu Adriana Mihaela
"Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
General Surgery Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania.
Maedica (Bucur). 2025 Jun;20(2):182-191. doi: 10.26574/maedica.2025.20.2.182.
Cardiovascular complications after non-cardiac surgery have a major impact on perioperative morbidity and mortality. Despite several scales and scores for assessing the preoperative cardiovascular status, an individualized assessment focused on each patient is mandatory.
To identify the new cardiac events that occur after non-cardiac surgery.
In 100 patients hospitalized in the general surgery department with acute and chronic surgical pathologies, the perioperative cardiac events were assessed using Holter monitoring along with clinical and biochemical markers, including C reactive protein (CRP) and high-sensitive troponin (hscTnI).
Out of the 100 participants with a mean age of 54.5 (43-77.9) years, 54% were men. Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related with longer surgery time 165 (150-180) vs 120 (90-150) minutes (p=0.002) and postoperative anaemia [haemoglobin (Hg) 10.4 (9.37-12.6) vs 12.1 (11-13.2) g/dL, (p=0.041)]. Higher CRP levels were also correlated with paroxysmal AF. The AF group correlated with higher values of presurgical CRP: 81 (46.5-186.75) vs 27 (6-102.5) mg/dL, (p=0.041). Higher postsurgical CRP values were also found in the AF group: 76 (47.75-110.75) vs 40.5 (12-82.5) mg/dL (p=0.045). Sinus pauses were present in nine patients and there was a strong association between sinus pauses and age (p = 0.011), history of high blood pressure (HBP) (p = 0.031), intraoperative HBP (p = 0.026) and the preexisting AF (p = 0.028). Postsurgical ST changes were present in 30 patients and ST depression was correlated with age (p < 0.001), prolonged surgery time [150 (120-180) vs 120 (90-150) minutes (p < 0.001)], history of HBP [(33.3% vs 12.2%) (p=0.017)] and intraoperative maximum values of BP (p = 0.007).
There is an increased risk of cardiovascular events during the postoperative period of non-cardiac surgery in patients with advanced age, pre-existing diseases (hypertension, preexisting atrial fibrillation, diabetes mellitus), the level of inflammation and longer intraoperative stress. Holter monitoring revealed rhythm and conduction disorders as well as ST segment changes that were associated with the inflammatory status and slightly elevated cardiac enzyme levels. Future studies are needed to see the impact of cardiac complications in the long term.
非心脏手术后的心血管并发症对围手术期发病率和死亡率有重大影响。尽管有多种用于评估术前心血管状况的量表和评分，但针对每个患者进行个体化评估是必不可少的。
确定非心脏手术后发生的新的心脏事件。
对普通外科住院的100例患有急慢性外科疾病的患者，使用动态心电图监测以及临床和生化指标（包括C反应蛋白（CRP）和高敏肌钙蛋白（hscTnI））评估围手术期心脏事件。
100名参与者的平均年龄为54.5（43 - 77.9）岁，其中54%为男性。10例患者发生术后阵发性心房颤动（AF），这与手术时间较长有关[165（150 - 180）分钟对120（90 - 150）分钟，（p = 0.002）]以及术后贫血[血红蛋白（Hg）10.4（9.37 - 12.6）对12.1（11 - 13.2）g/dL，（p = 0.041）]。较高的CRP水平也与阵发性AF相关。AF组术前CRP值较高：81（46.5 - 186.75）对27（6 - 102.5）mg/dL，（p = 0.041）。AF组术后CRP值也较高：76（47.75 - 110.75）对40.5（12 - 82.5）mg/dL（p = 0.045）。9例患者出现窦性停搏，窦性停搏与年龄（p = 0.011）、高血压病史（HBP）（p = 0.031）、术中HBP（p = 0.026）和既往AF（p = 0.028）之间存在密切关联。30例患者出现术后ST段改变，ST段压低与年龄（p < 0.001）、手术时间延长[150（120 - 180）分钟对120（90 - 150）分钟（p < 0.001）]、HBP病史[（33.3%对12.2%）（p = 0.017）]和术中血压最大值（p = 0.007）相关。
高龄、存在基础疾病（高血压、既往心房颤动、糖尿病）、炎症水平以及术中应激时间较长的患者，在非心脏手术后的围手术期发生心血管事件的风险增加。动态心电图监测显示节律和传导障碍以及ST段改变，这些与炎症状态和心脏酶水平略有升高有关。需要进一步的研究来观察心脏并发症的长期影响。
