[Influencing factors for major cardiovascular adverse events in elderly patients following major thoracic and abdominal surgery].

چکیده اصلی

Objective: To explore the factors influencing major adverse cardiovascular events (MACE) in elderly patients undergoing major thoracic and abdominal surgery. Methods: The perioperative data of elderly patients (≥65 years) who underwent elective non-cardiac major thoracic and abdominal surgery (≥2 hours) under general anesthesia at Peking University First Hospital from November 1, 2021 to July 31, 2023, were retrospectively collected. The data included age, sex, body mass index (BMI), comorbidities, smoking history, American Society of Anesthesiologists (ASA) classification, laboratory test results, use of regional blockade, anesthesia duration, type of surgery, surgical duration, and fluid intake and output. Patients were divided into a MACE group and a non-MACE group according to whether MACE occurred postoperatively. Multivariate logistic regression analysis was used to identify the influencing factors for postoperative MACE. Results: A total of 1 915 patients were enrolled, including 1 252 males and 663 females, with a mean age of (72±5) years. The incidence of perioperative MACE was 4.6% (88/1 915). Multivariate logistic regression analysis revealed that older age (OR=1.051, 95%CI: 1.007-1.097, P=0.023), higher BMI (OR=1.111, 95%CI: 1.033-1.195, P=0.005), preoperative coronary heart disease (OR=1.934, 95%CI: 1.107-3.381, P=0.021), preoperative hyperthyroidism (OR=28.691, 95%CI: 3.207-256.640, P=0.003), higher preoperative alanine transaminase (ALT) (OR=1.007, 95%CI: 1.001-1.014, P=0.021), higher preoperative B-type natriuretic peptide (BNP)(OR=1.003, 95%CI: 1.002-1.004, P<0.001), and longer surgical duration (OR=1.003, 95%CI: 1.001-1.005, P=0.011) were risk factors for postoperative MACE, whereas intraoperative regional blockade was identified as a protective factor against postoperative MACE (OR=0.310, 95%CI: 0.189-0.508, P<0.001). Conclusions: Older age, higher BMI, preoperative hyperthyroidism, higher preoperative ALT and BNP levels, and longer surgical duration are associated with an increased risk of postoperative MACE in elderly patients undergoing major thoracic and abdominal surgery, while intraoperative regional blockade may have a protective effect against postoperative MACE.

ترجمه فارسی چکیده

هدف: بررسی عوامل مؤثر بر رویدادهای قلبی عروقی بدخیم اصلی (MACE) در بیماران مسن undergoing جراحی بزرگ قفسه سینه و شکم. روش‌ها: داده‌های دوران جراحی بیماران مسن (≥65 سال) undergoing جراحی‌های غیرقلبی بزرگ قفسه سینه و شکم (≥2 ساعت) تحت بیهوشی عمومی در بیمارستان اول دانشگاه پکن از 1 نوامبر 2021 تا 31 ژوئیه 2023 جمع‌آوری شدند. نتایج: 1,915 بیمار enrolled شدند. شیوع MACE 4.6% بود. عوامل خطر: افزایش سن، BMI بالاتر، بیماری قلبی عروقی کرونر قبل از عمل، هیپرتیروئیدم قبل از عمل، ALT و BNP بالاتر، و مدت زمان جراحی طولانی‌تر. عامل محافظ: بلاک محلی داخل عمل.

متن کامل اصلی