2022 年第 5 期 第 17 卷

曾行冠状动脉支架置入老年患者骨科手术的围术期评估及术后效果分析

Perioperative evaluation and postoperative effect analysis of orthopaedic surgery in elderly patients with previous coronary stent implantation

作者：王永伟孙明曜胡三保

英文作者：Wang Yongwei Sun Mingyao Hu Sanbao

单位：首都医科大学附属北京安贞医院骨科，北京100029

英文单位：Department of Orthopaedics Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：骨科手术；冠状动脉支架置入；围术期；主要不良心血管事件

英文关键词：Orthopaedicsurgery;Coronarystentimplantation;Perioperation;Majoradversecardiovascularevents

• 摘要：

• 目的 探讨曾行冠状动脉支架置入老年患者骨科Ⅲ、Ⅳ级手术围术期评估方案及术后效果，为临床医师提供方法参考。方法 回顾性分析2016年1月至2020年9月首都医科大学附属北京安贞医院骨科收治的84例老年Ⅲ、Ⅳ级骨科手术患者的临床资料。将术前曾行冠状动脉支架置入的42例患者纳入观察组，未行冠状动脉支架置入的42例患者纳入对照组。比较2组患者的临床基线资料、手术情况、术后功能恢复情况及术中术后主要不良心血管事件发生率。结果 2组患者性别、年龄、合并疾病及改良心脏风险指数分级比较差异均无统计学意义(均P>0.05)。2组患者均顺利完成手术，无死亡患者，均安全度过围术期。观察组与对照组功能优良率、术中及术后主要不良心血管事件发生率差异均无统计学意义［83.3%（35/42）比85.7%（36/42）、11.9%（5/42）比9.5%（4/42）］（χ2=0.091，P=0.763； χ2=0.124，P=0.724）。结论  经过术前规范评估、合理干预后，曾行冠状动脉支架置入的老年患者能够耐受各类骨科Ⅲ、Ⅳ级手术，并可以取得较好的临床效果。

• Objective  To explore the perioperative evaluation scheme and postoperative effect of orthopaedic surgery grading Ⅲ and Ⅳ in elderly patients with previous coronary stent implantation, so as to provide a reference for clinicians. Methods The clinical data of 84 elderly patients who underwent orthopaedic surgery grading Ⅲ and Ⅳ in Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University from January 2016 to September 2020 were analyzed retrospectively. Forty-two patients who had previous coronary stent implantation were included in the observation group, and 42 patients who had no previous coronary stent implantation were included in the control group. The baseline data, operation conditions, postoperative functional recovery and the incidence of major adverse cardiovascular events during and after operation were compared between the two groups. Results  There were no significant differences in gender, age, combined diseases and modified cardiac risk index between the two groups(all P>0.05). All the patients had successful operation without death， and had a safe perioperative period. There were no significant differences in the excellent and good function rate and the incidence of major adverse cardiovascular events during and after operation between the observation group and the control group［83.3%(35/42) vs 85.7%(36/42), 11.9%(5/42) vs 9.5%(4/42)］(χ2=0.091, P=0.763; χ2=0.124, P=0.724）. Conclusion After standardized preoperative evaluation and reasonable intervention, the elderly patients who had previous coronary stent implantation can tolerate orthopedic surgery grading Ⅲ and Ⅳ, and can achieve good clinical results.