【罂粟摘要】术前贫血与非心脏手术后心肌损伤:一项回顾性研究

术前贫血与非心脏手术后心肌损伤:一项回顾性研究

贵州医科大学 高鸿教授课题组

翻译:佟睿    编辑:佟睿    审校:曹莹

背景

术前贫血与非心脏手术的不良结局有关,但其与非心脏手术后心肌损伤(MINS)的相关性尚未得到充分研究。

目的

探究术前贫血与MINS的关系。

试验设计

一项单中心回顾性队列研究。

范围设置

三级医疗转诊中心。

受试人群

非心脏手术后测定心肌肌钙蛋白(CTn)I水平的患者。

干扰因素

根据术前贫血(男性<13g·dl-1,女性<12g·dl-1)进行分类。血红蛋白水平阈值为11g·dl-1时,贫血进一步分为轻度及中重度。

主要观察指标测定

主要观察指标是发生MINS,其定义为术后30天内cTnI峰值水平超过参考上限的99%。

结果

本研究共收集到35170例患者资料,其中正常组22062例(62.7%),贫血组13108例(37.3%)。经倾向性评分匹配后,共产生11919组患者,MINS的发生率与贫血显著相关[14.5% vs. 21.0%,OR1.57,95%可信区间1.47 - 1.68,P<0.001]。多变量分析显示,在整个人群中,贫血严重程度与MINS之间存在分级关联(与正常组相比,轻度贫血OR1.32,95%CI: 1.22~1.43,P<0.001;中重度贫血OR1.80,95%CI: 1.66~1.94,P<0.001);中重度贫血MINS发生率显著高于轻度贫血(18.6 vs. 28.6%,OR1.37,95%CI: 1.25~1.5,P<0.001)。术前与MINS相关的血红蛋白阈值估计为12.2g·dl-1,曲线下面积为0.622。

结论

术前贫血与MINS独立相关,提示MINS可能与贫血及术后死亡率有关。

试验登记

SMC 2019-08-048

Pre-operative anaemia and myocardial injury after noncardiac surgery: A retrospective study

BACKGROUND Pre-operative anaemia is associated with adverse outcomes of noncardiac surgery, but its association with myocardial injury after noncardiac surgery (MINS) has not been fully investigated.

OBJECTIVE The association between pre-operative anaemia and MINS. DESIGN A single-centre retrospective cohort study. SETTING Tertiary care referral centre.

PATIENTS Patients with measured cardiac troponin (cTn) I levels after noncardiac surgery.

INTERVENTIONS Patients were separated according to pre-operative anaemia (haemoglobin <13 g dl-1 in men and <12 g dl-1 in women). Anaemia was further stratified into mild and moderate-to-severe at a haemoglobin level threshold of 11 g dl-1.

MAIN OUTCOME MEASURES The primary outcome was MINS, defined as a peak cTnI level more than 99th percentile of the upper reference limit within 30 postoperative days.

RESULTS Data from a total of 35 170 patients were collected, including 22 062 (62.7%) patients in the normal group and 13 108 (37.3%) in the anaemia group. After propensity score matching, 11919 sets of patients were generated, and the incidence of MINS was significantly associated with anaemia [14.5 vs. 21.0%, odds ratio (OR) 1.57, 95% confidence interval (CI) 1.47 to 1.68, P<0.001]. For the entire population, multivariable analysis showed a graded association between anaemia severity and MINS (OR 1.32, 95% CI 1.22 to 1.43, P<0.001 for mild anaemia and OR 1.80, 95% CI 1.66 to 1.94, P<0.001 for moderateto-severe anaemia compared with the normal group) and a significantly higher incidence of MINS for moderate-tosevere anaemia than mild anaemia (18.6 vs. 28.6%, OR 1.37, 95% CI 1.25 to 1.50, P<0.001). The estimated threshold for pre-operative haemoglobin associated with MINS was 12.2 g dl-1, with an area under the curve of 0.622.

CONCLUSIONS Pre-operative anaemia was independently associated with MINS, suggesting that MINS may be related to the association between anaemia and postoperative mortality.

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