作者：王雪静，梅玲，张转，张海霞

单位：

225300 江苏省扬州市，扬州大学附属医院手术室 通信作者：张海霞，E-mail：28709235@qq.com

Units：

Operating Room, Affiliated Hospital of Yangzhou University, Yangzhou 225300, China Corresponding author: ZHANG Haixia, E-mail: 28709235@qq.com

关键词：

高血压; 老年人; 非心脏手术; 围手术期; 主要不良心血管事件; 影响因素分析; 列线图模型;

Keywords：

Hypertension; Aged; Non-cardiac surgery; Perioperative period; Major adverse cardiovascular events;Root cause analysis; Nomogram model

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.266

Funds：

江苏省卫生健康委员会基金面上项目（H2018049）

摘要：

背景临床上老年高血压患者非心脏手术围术期发生主要不良心血管事件(MACE)的风险较高,通过构建个体化预测非心脏手术围术期发生MACE的列线图模型极其重要。目的构建老年高血压患者非心脏手术围术期MACE发生风险列线图模型,并评估其区分度和一致性。方法选取2017年3月至2021年1月扬州大学附属医院收治的择期进行非心脏手术的老年高血压患者244例为研究对象。根据患者非心脏手术围术期MACE发生情况,将其分为MACE组(58例)和非MACE组(186例)。收集患者临床资料,采用单因素分析及多因素Logistic回归分析探讨老年高血压患者非心脏手术围术期发生MACE的影响因素;将确定的影响因素引入R 3.6.3软件及rms程序包,构建预测老年高血压患者非心脏手术围术期MACE发生风险的列线图模型;绘制受试者工作特征(ROC)曲线以评估该列线图模型的区分度,采用校准曲线与Hosmer-Lemeshow拟合优度检验评估其一致性。结果多因素Logistic回归分析结果显示,高血压分级[OR=4.432,95%CI(1.661,11.827)]、ST段压低≥0.05 mV[OR=2.894,95%CI(1.366,6.131)]、术中输入浓缩红细胞量[OR=1.014,95%CI(1.010,1.019)]、冠心病[OR=2.444,95%CI(1.172,5.099)]是老年高血压患者非心脏手术围术期发生MACE的影响因素(P <0.05)。基于多因素Logistic回归分析结果,构建预测老年高血压患者非心脏手术围术期MACE发生风险的列线图模型,该列线图模型预测老年高血压患者非心脏手术围术期发生MACE的曲线下面积为0.825[95%CI(0.766,0.884)]。列线图模型预测老年高血压患者非心脏手术围术期MACE发生风险的校准曲线与实际曲线基本吻合,且Hosmer-Lemeshow拟合优度检验结果显示,χ2=8.958、P=0.346。结论高血压分级、ST段压低≥0.05 mV情况、术中输入浓缩红细胞量、冠心病是老年高血压患者非心脏手术围术期发生MACE的影响因素,本研究基于以上4项影响因素构建的老年高血压患者非心脏手术围术期MACE发生风险列线图模型的区分度和一致性均较好。

Abstract：

【Abstract】　Background Clinically, elderly patients with hypertension have a higher risk of major adversecardiovascular events (MACE) during perioperative period of non-cardiac surgery. It is very important to build an individualizednomogram model to predict MACE during perioperative period of non-cardiac surgery. Objective To construct a nomogrammodel for MACE risk during perioperative period of non-cardiac surgery in elderly patients with hypertension, and evaluate itsdiscrimination and consistency. Methods A total of 244 elderly patients with hypertension with elective non-cardiac surgerywho were admitted to Affiliated Hospital of Yangzhou University from March 2017 to January 2021 were selected as the researchobjects. According to the incidence of MACE during perioperative period of non-cardiac surgery, the patients were divided intoMACE group (58 cases) and non-MACE group (186 cases) . The clinical data of patients were collected, univariate analysis andmultivariate Logistic regression analysis were used to explore the influencing factors of MACE during perioperative period of noncardiac surgery in elderly patients with hypertension; the determined influencing factors were introduced into R 3.6.3 software andrms package to construct a nomogram model to predict the risk of MACE during perioperative period of non-cardiac surgery inelderly patients with hypertension; the receiver operating characteristic (ROC) curve was drawn to evaluate the discrimination ofthe nomogram model, and its consistency was evaluated by calibration curve and Hosmer-Lemeshow goodness of fit test. ResultsMultivariate Logistic regression analysis showed that hypertension grade [OR=4.432,95%CI (1.661, 11.827) ] , ST segmentdepression≥ 0.05 mV [OR=2.894, 95%CI (1.366, 6.131) ] , intraoperative input of concentrated red blood cells [OR=1.014,95%CI(1.010, 1.019) ] , coronary heart disease [OR=2.444, 95%CI (1.172, 5.099) ] were the influencing factors of MACE duringperioperative period of non-cardiac surgery in elderly patients with hypertension (P< 0.05) . Based on the results of multivariateLogistic regression analysis, a nomogram model was constructed to predict the risk of MACE during perioperative period of noncardiac surgery in elderly patients with hypertension. The area under curve of nomogram model in predicting the MACE duringperioperative period of non-cardiac surgery in elderly patients with hypertension was 0.825 [95%CI (0.766, 0.884) ] . Thecalibration curve of the nomogram model for predicting the risk of MACE during perioperative period of non-cardiac surgery inelderly patients with hypertension was basically consistent with the actual curve, and the Hosmer-Lemeshow goodness of fit testshowed thatχ2 =8.958, P=0.346. Conclusion Hypertension grade, ST-segment depression ≥ 0.05 mV, intraoperative input ofconcentrated red blood cells, and coronary heart disease are the influencing factors of MACE during perioperative period of noncardiac surgery in elderly patients with hypertension. In this study, the nomogram model for MACE risk during perioperative periodof non-cardiac surgery in elderly patients with hypertension constructed based on the above 4 factors has good discrimination andconsistency.

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