非心脏手术后的心肌损伤及其与短期死亡率的关联
Judith A R van Waes1, Hendrik M Nathoe, Jurgen C de Graaff
1Department of Anesthesiology, University Medical Center Utrecht, Local Mail Q04.2.313, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Circulation
|May 14, 2013
概括
术后心肌损伤,通过托波升高检测,独立预测非心脏手术患者的30天死亡率. 常规的激素监测可能会改善患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 在外科手术期间的医学.
- 临床诊断 临床诊断 临床诊断
背景情况:
- 建议进行常规的心脏托罗宁监测,以确定非心脏手术后有死亡风险的患者.
- 这项研究评估了对30天死亡率的热素升高的预测值.
研究的目的:
- 为了确定术后心肌损伤是否通过托波水平来预测非心脏手术后的30天死亡率.
- 评估实施托罗邦尼监测作为标准护理的可行性和实用性.
主要方法:
- 一项观察性单中心队列研究,对2232名年龄≥60岁的中高风险非心脏手术患者进行了观察.
- 在手术后的前3天测量了托罗邦尼I水平.
- 逻辑二项式回归分析了热素升高 (>0.06μg/L) 与所有原因的30天死亡率之间的关联.
主要成果:
- 在19%的患者 (315/1627) 中检测到术后心肌损伤.
- 所有原因的30天死亡率发生在3%的患者中 (56/2232).
- 高水平的热素显著增加了30天死亡的风险 (RR2.4对于轻微升高,RR4.2对于较大的升高).
结论:
- 手术后心肌损伤是非心脏手术后30天死亡率的独立预测因素.
- 实施常规的激素监测是可行的,并可能有助于改善患者的预后.
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