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| 肥厚型心肌病患者行非心脏手术后并发症的危险因素 |
| Risk factors for postoperative complications in patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery |
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| DOI：10.12089/jca.2026.07.006 |
| 中文关键词: 肥厚型心肌病 非心脏手术 术后并发症 危险因素 心律失常 左心室最大径 |
| 英文关键词: Hypertrophic cardiomyopathy Non-cardiac surgery Postoperative complications Risk factors Arrhythmia Left ventricular maximum diameter |
| 基金项目:吴阶平医学基金会临床科研专项资助基金（320.6750.2024-15-39） |
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| 中文摘要: |
目的：探讨肥厚型心肌病患者行非心脏手术后并发症的发生情况及其危险因素。
方法：本研究为回顾性队列研究，收集接受非心脏手术的肥厚型心肌病患者资料，年龄19～93岁，ASA Ⅰ—Ⅳ级。根据住院期间是否出现术后并发症将患者分为两组：并发症组和非并发症组。术后并发症定义为住院期间新发的Clavien-Dindo分级Ⅰ级及以上并发症。收集人口学信息、既往病史、术前实验室检查、超声心动图指标以及麻醉和手术相关资料，采用多因素Logistic回归筛选术后并发症的危险因素。
结果：共纳入患者660例，有152例（23.0%）发生术后并发症。多因素Logistic回归分析显示，ASA Ⅳ级（OR=1.45，95%CI 1.03～2.05，P=0.032）、术前存在心律失常（OR=1.14，95%CI 1.07～1.23，P＜0.001）、术中出血量偏多（OR=1.06，95%CI 1.00 ～1.12，P=0.020）、手术时间偏长（OR=1.06，95%CI 1.00～1.13，P=0.040）是术后并发症的独立危险因素，术前血红蛋白水平偏高（OR=0.95，95%CI 0.91～0.98，P=0.003）、左心室最大径偏大（OR=0.69，95%CI 0.55～0.88，P=0.002）是术后并发症的保护因素。
结论：肥厚型心肌病患者行非心脏手术时，ASA Ⅳ级、术前存在心律失常、术中出血量偏多、手术时间偏长是术后并发症的独立危险因素，术前血红蛋白水平偏高、左心室最大径偏大则有保护作用。 |
| 英文摘要: |
Objective: To investigate the rate and risk factors for postoperative complications in patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery.
Methods: This was a retrospective cohort study. Patients aged 19-93 years with hypertrophic cardiomyopathy and ASA physical status Ⅰ-Ⅳ undergoing non-cardiac surgery were included. The patients were divided into two groups based on whether they developed complications during hospitalization: the complication group and the non-complication group. Postoperative complications were defined as newly developed complications of Clavien-Dindo grade I or higher during hospitalization. Demographic information, medical history, preoperative laboratory test, echocardiographic parameters, as well as anesthesia and surgery related data were collected. Multivariable logistic regression was used to identify risk factors for postoperative complications.
Results: A total of 660 patients were included, and postoperative complications occurred in 152 patients (23.0%). Multivariable logistic regression analysis showed that ASA physical status Ⅳ (OR = 1.45, 95%CI 1.03-2.05, P = 0.032), preoperative arrhythmia (OR = 1.14, 95% CI 1.07-1.23, P < 0.001), greater intraoperative blood loss (OR = 1.06, 95% CI 1.00-1.12, P = 0.020), and longer operation duration (OR = 1.06, 95% CI 1.00-1.13, P = 0.040) were independent risk factors for postoperative complications. Higher preoperative hemoglobin level (OR = 0.95, 95% CI 0.91-0.98, P = 0.003) and larger left ventricular maximum diameter (OR = 0.69, 95% CI 0.55-0.88, P = 0.002) were protective factors for postoperative complications.
Conclusion: For patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery, ASA physical status Ⅳ, preoperative arrhythmia, greater intraoperative blood loss, and longer operation duration are independent risk factors for postoperative complications, whereas higher preoperative hemoglobin level and larger left ventricular maximum diameter have protective effects. |
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