中国实用外科杂志

中国实用外科杂志

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心脏瓣膜置换术后病人接受普通外科手术安全性评价

陈    凌，孙    杰，陈    昊，刘凤林，秦    净，孙益红，秦新裕   

  1. 复旦大学附属中山医院普外科，上海200032
  • 出版日期:2019-11-01 发布日期:2019-11-12

  • Online:2019-11-01 Published:2019-11-12

摘要：

目的    对心脏瓣膜置换术后病人接受普通外科手术的安全性加以评价。方法    通过回顾性分析2010—2016年复旦大学附属中山医院普通外科162例（164例次）接受普通外科手术（不含血管外科和肝脏外科手术）的心脏瓣膜置换术后病人的人口学特征、基础疾病、术前实验室检查、手术相关信息等临床数据，应用单变量和多变量分析来确定与主要出血事件和非出血性并发症相关的风险因素。结果    162例（164例次）手术中，12例（7.3%）围手术期发生主要出血事件，27例（16.5%）术后发生非出血性并发症。7例（4.3%）病人围手术期发生Ⅲ级并发症，1例（0.6%）病人死亡（V级）。急诊手术与择期手术相比，主要出血事件的发生率显著增高（25.0% vs. 4.9%，P = 0.007），非出血性并发症发生率差异无统计学意义（15.0% vs. 16.7%，P=1.000）。围手术期发生主要出血事件的风险因素包括急诊手术［比值比（OR）=6.455，95%置信区间（CI） 1.672~24.472，P=0.008］、手术时间 ≥ 60 min（OR=14.989，95%CI 1.683-2015.140，P=0.009），以及主动脉瓣膜置换（OR = 3.408，95%CI 1.001-12.191，P=0.050）。术后发生非出血性并发症的风险因素是胃肠道手术（OR = 4.323，95%CI 1.740-11.629，P = 0.002）和房颤（OR=2.717，95%CI 1.053-7.022，P=0.037）。结论    心脏瓣膜置换术后病人可以安全的接受普通外科择期手术，而且，只要进行规范的围手术期抗凝和抗血栓治疗管理，急诊手术的出血性并发症风险同样安全可控。

关键词: 心脏瓣膜置换, 普通外科, 围手术期并发症

Abstract:

Safety evaluation of patients with heart valve replacement undergoing general surgery        CHEN Ling, SUN Jie, CHEN Hao, et al. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: LIU Feng-lin, E-mail: liu.fenglin@zs-hospital.sh.cn
Abstract    Objective    To evaluate the safety in patients with heart valves replacement undergoing general surgery. Methods    From 2010 to 2016, the clinical data of demographic characteristics, comorbidities, preoperative laboratory tests, and surgical operation related information of 164 cases with heart valves replacement after general surgery in Department of General Surgery, Zhongshan Hospital, Fudan University, were collected retrospectively. Univariate and multivariate analysis were applied to identify the risk factors associated with major bleeding events and non-hemorrhagic complications. Results    Among 164 cases, 12 patients (7.3%) presented major bleeding events, and 27 patients (16.5%) presented non-hemorrhagic complications. Seven patients (4.3%) suffered grade Ⅲ perioperative complications and one patient (0.6%) died （grade Ⅴ）. The incidence of major bleeding events was significantly higher in emergent patients than in elective surgery (25.0% vs. 4.9%, P=0.007), and there was no significant difference in the incidence of non-hemorrhagic complications (15.0% vs. 16.7%, P=1.000). Significant risk factors for major bleeding events included emergency surgery [odds ratio (OR) 6.455, 95% confidence interval (CI) 1.672-24.472, P=0.008], operative time ≥ 60 minutes (OR=14.989，95%CI 1.683-2015.140, P=0.009), as well as aortic valve replacement (OR=3.408，95%CI 1.001-12.191, P=0.050). Significant risk factors for non-hemorrhagic complications were gastrointestinal surgery (OR=4.323，95%CI 1.740-11.629, P=0.002) and atrial fibrillation (OR=2.717，95%CI 1.053-7.022, P=0.037). Conclusion    Patients with heart valve replacement can undergo elective general surgery safely. The risk of hemorrhagic complications in emergency surgery is acceptable, as long as the standardized perioperative anticoagulation and antithrombotic management is carried out.

Key words: heart valve replacement, general surgery, perioperative complication