睡眠呼吸障碍患者择期手术后发生主要心脑血管并发症的风险

2020
09/10

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米勒之声
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睡眠呼吸障碍患者择期手术后发生主要心脑血管并发症的风险

背景:睡眠呼吸障碍(SDB)是否与术后主要的心脑血管事件发生率(MACCE)和患者死亡率增加有关,目前的研究有限且相互矛盾。

目的:研究SDB是否与MACCE发生率、患者死亡率和住院时间增加相关。

设计:来自全国住院患者样本的回顾性队列分析。

受试者:2011年至2014年期间在美国接受择期腹部、整形外科、前列腺、妇科、胸科、移植、血管或心脏手术的成年患者。

研究对象:研究队列包括1813974名外科患者,其中185615名(10.2%)患有SDB。急诊手术被排除在外。

主要结果指标:根据SDB诊断标准对MACCE、呼吸和血管并发症、住院死亡率和平均住院时间进行队列分层。通过线性回归模型来确定SDB和主要结果指标之间的相关性。

结果:SDB组患者MACCE(25.3vs.19.8%,OR=1.2,P<0.001)和呼吸系统并发症(11.75vs.8.0%,OR1.43,P<0.001)的发生率明显高于非SDB组患者。SDB与房颤(14.7vs.10.8%,P<0.001)、其他心律失常(6.0vs.5.4%,P<0.001)和充血性心力衰竭(9.8vs.7.1%,P<0.001)高发生率相关。SDB患者心肌梗死发生率较低(3.1vs3.4%,或0.69,P<0.001),死亡率较低(0.6vs1.3%,P<0.001),住院时间较短(4.8天vs5.2天,P<0.001)。

结论:SDB与MACCE、呼吸和血管并发症的发生风险增加有关,但患者死亡率较低,住院时间较短。

原始文献来源: Chaudhry R, Suen C, Mubashir T, et al. Risk of major cardiovascular and cerebrovascular complications after elective surgery in patients with sleep-disordered breathing:A retrospective cohort analysis[J].Eur J Anaesthesiol 2020 Aug;37(8) DOI:10.1097/EJA.0000000000001267

Risk of major cardiovascular and cerebrovascular complications after elective surgery in patients with sleep-disordered breathing:A retrospective cohort analysis

Abstract

BACKGROUND There is limited and conflicting data on whether sleep-disordered breathing (SDB) is associated with postoperative major cardiovascular and cerebrovascular events (MACCE), and mortality.

OBJECTIVES To determine whether SDB is associated with increased risks of MACCE, mortality and length of hospital stay.

DESIGN Retrospective cohort analysis from the Nationwide Inpatient Sample.

SETTING Adults who underwent elective abdominal, orthopaedic, prostatic, gynaecological, thoracic, transplant, vascular or cardiac surgery in the United States of America between 2011 and 2014.

PATIENTS The study cohort included 1813 974 surgical patients, of whom 185 615 (10.2%) had SDB. Emergency or urgent surgical procedures were excluded.

MAIN OUTCOME MEASURES The incidences of MACCE,respiratory and vascular complications, in-hospital mortality and mean length of hospital stay were stratified by SDB.Linear and logistic regression models were constructed to determine the independent association between SDB and outcomes of interest.

RESULTS The incidences of MACCE [25.3 vs. 19.8%, odds ratio (OR) 1.20, P<0.001] and respiratory complications (11.75 vs. 8.0%, OR 1.43, P<0.001) were significantly higher in patients with SDB than in those without SDB.SDB was associated with higher rates of atrial fibrillation(14.7 vs. 10.8%,P<0.001), other arrhythmias (6.0 vs. 5.4%,P<0.001) and congestive heart failure (9.8 vs. 7.1%,P<0.001). SDB patients had a lower rate of myocardial infarction (3.1 vs. 3.4%, OR 0.69, P<0.001), lower mortality (0.6 vs. 1.3%, P<0.001) and shorter length of hospital stay(4.8 vs. 5.2 days, P<0.001).

CONCLUSION SDB was associated with increased risks of MACCE, and respiratory and vascular complications, but had a lower incidence of in-hospital mortality and shorter length of hospital stay.

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本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:guikequan@hmkx.cn
关键词:
死亡率,睡眠呼吸障碍

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