退变性腰椎疾病患者经后路腰椎融合手术后心脏不良事件危险因素分析

The risk factors of major adverse cardiac events after posterior lumbar spinal fusion in patients with degenerative lumbar spinal disorders

中文关键词:  腰椎退变性疾病  后路腰椎融合术  心脏不良事件  危险因素

英文关键词:Degenerative lumbar spinal disorders  Posterior lumbar spinal fusion  Major adverse cardiac events  Risk factors

中文摘要:

  【摘要】 目的：探讨与退变性腰椎疾病患者经后路腰椎融合手术后发生心脏不良事件可能相关的因素。方法：回顾性分析2018年1月～2023年7月因腰椎退变性疾病在北京安贞医院接受后路腰椎融合手术的96例患者临床资料，其中男性53例，女性44例，平均年龄64.1±10.1岁。依据腰椎融合术后1年内是否出现心脏不良事件（心脏骤停、新发或是加重心律失常、急性心肌梗死或是心绞痛及心力衰竭）进行分组，比较两组患者一般情况[查理森共病指数（Charlson comorbidity index，CCI）、美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级、改良心脏危险指数（revised cardiac risk index，RCRI）等]、术前检查（血红蛋白、血浆白蛋白、心脏超声射血分数等）、手术参数（手术有创性Mirza分级、手术时间、术中估计失血量等）以及术中监测指标（基线平均动脉压、术中尿量、自体血回输量等）的差异。结果：腰椎融合术后未发生心脏不良事件组患者CCI、RCRI、超声心动E波最大流速、术中估计失血量、基线平均动脉压以及术中自体血回输均明显小于发生心脏不良事件组（0.9±1.0 vs 1.6±1.5；1.5±0.7 vs 2.0±0.8；70.3±18.2 vs 82.6±36.9；705±560.6 vs 1193±1332.9；103.6±15.9 vs 112.1±12.1；399.5±368.3 vs 637.6±470.5），差异均有统计学意义（P＜0.05）。多因素回归分析提示CCI和术中估计失血量与术后发生心脏不良事件存在统计学相关性（OR=1.968，P=0.007；OR=1.001，P=0.023）。结论：退变性腰椎疾病患者经后路腰椎融合术后发生心脏不良事件可能与患者查理森共病指数及手术失血量密切相关。

英文摘要:

  【Abstract】 Objectives: To explore the factors that may be associated with the occurrence of major adverse cardiac events(MACEs) after posterior lumbar spinal fusion in patients with degenerative lumbar spinal disorders. Methods: The clinical data of 96 patients who underwent lumbar spinal fusion for degenerative lumbar spinal disorders at Beijing Anzhen Hospital from January 2018 to July 2023 were retrospectively analyzed, 53 males and 44 females were included with the average age of 64.1±10.1 years. The patients were grouped according to whether MACEs(cardiac arrest, new or worsening arrhythmia, acute myocardial infarction, or angina pectoris and heart failure) occurred within 1 year after lumbar spine fusion surgery. The general conditions[American Society of Anesthesiologists(ASA) classification, Charlson comorbidity index(CCI), revised cardiac risk index(RCRI), etc.], preoperative examinations(hematocrit, serum albumin, left ventricular ejection fraction, etc.), surgical parameters(Mirza invasiveness of the surgery index, operative time, estimated blood loss, etc.), and intraoperative monitoring indexes(baseline mean artery pressure, urine output, autonomous blood transfusion, etc.) were compared between the two groups. Results: The CCI index, RCRI index, echocardiograph E-wave maximal flow rate, estimated intraoperative blood loss, baseline mean arterial pressure, and intraoperative autologous blood transfusion in the group without MACEs were significantly lower than those in the group with (0.9±1.0 vs 1.6±1.5; 1.5±0.7 vs 2.0±0.8; 70.3±18.2 vs 82.6±36.9; 705±560.6 vs 1193±1332.9; 103.6±15.9 vs 112.1±12.1; 399.5±368.3 vs 637.6±470.5), with statistically significant differences(P＜0.05). Multifactorial logistic regression analysis suggested that both the CCI index and estimated intraoperative blood loss were correlated with the MACEs statistically(OR=1.968, P=0.007; OR=1.001, P=0.023). Conclusions: The CCI and operative blood loss may be associated with the MACEs after posterior lumbar spinal fusion in patients with degenerative lumbar spinal disorders.