Risk factors for cardiac rhythm disturbances and blood pressure variation during maxillofacial, ear, nose and throat operations

[T. Ivošević]

236 listova

medicina - kardiologija / medicine - cardiology

Cilj rada je da se odredi učestalost i faktori rizika za pojavu intraoperativnih poremećaja srčanog ritma i variranja krvnog pritiska. Metodologija: Ova kohortna, retrospektivna studija, uključila je 2304 pacijenta podvrgnuta maksilofacijalnoj ili hirurgiji uva, grla ili nosa. Ispitivani su sledeći faktori rizika: pol, životno doba, ASA status, otežana intubacija, vrsta hirurgije, trajanje anestezije, intraoperativna transfuzija, indukovana hipotenzijai sledeći komorbiditeti: hipertenzija, kardiomiopatija, poremećaji srčanog ritma, ishemijska bolest srca, prethodni cerebrovaskularni insult, hronična bubrežna insuficijencija, hiperlipoproteinemija i dijebetes melitus. Registrovani su sledeći intraoperativni poremećaji: hipertenzija, hipertenzivna kriza i poremećaji srčanog ritma (tahikardija, bradikardija, novonastala intraoperativna atrijalna fibrilacija, supraventrikularne i ventrikularne ekstrasistole). Za statističku obradu korišćen je Mann Whitney U test, Pirson-ov2test (tablicekontingencije), logistička regresiona analiza i ROC krive. Rezultati: Većina bolesnika je bila muškog pola pola (63.2%), starija od 50 godina i ASA1 klase (48%). Najviše bolesnika bilo je podvrgnuto hirurgiji grla (38.2%). Intraoperativno variranje krvnog pritiska i/ ili intraoperativne poremećaje srčanog ritma imalo je 29.4% pacijenata. Najveća učestalost intraoperativnih minor srčanih komplikacija bila je u maksilofacijalnoj hirurgiji (35.4%), odmah zatim u hirurgiji uva (35.1%),a najređe u hirurgiji nosa (21.3%). Od svih minor srčanih komplikacija najčešća je bila bradikardija (20.5%), zatim hipertenzija (5.3%), tahikardija (4.7%), ventrikularne ekstrasistole (0.5%), supraventrikularne ekstrasistole (0.3%), dok novonastala intraoperativn aritmija absoluta nije registrovana ni kod jednog pacijenta. Logističkom regresijom kao faktori rizika izdvojili su se: prethodna srčana aritmija, trajanje anestezije, indukovana hipotenzija i hirurgija uva. Zaključak: Intraoperativno variranje krvnog pritiska i poremećaji srčanog ritma, naročito bradikardija, su česti tokom maksilofacijalne i hirurgije uva, grla i nosa i to pre svega kod pacijenata sa prethodnim srčanim aritmijama i indukovanom hipotenzijom. Hirurgija uva i duže trajanje anestezije, takođe povećavaju rizik za nastanak intraoperativnih poremećaja srčanog ritma i variranja krvnog pritiska.

The aim of our study was to determine the incidence and the risk factors for intraoperative cardiac rhythm disturbances and blood pressure variation in maxillofacial, ear, nose and throat surgery. Methods: This cohort retrospective study included 2304 patients who underwent either maxillofacial, ear, nose or throat surgery. These risk factors were studied:gender,age, ASA status, difficult airway management, type of surgery, duration of anaesthesia, intraoperative transfusion,induced hypotension and comorbidity such as: hypertension,cardiomyopathy,cardiac arrhythmias, ischemic heart disease, history of cerebrovascular insult,chronic kidney disease,hyperlipoproteinemiaana diabetes mellitus. These intraoperative minor cardiac complications were registered: hypertension, hypertension crisis, tachycardia, bradycardia, new onset of atrial fibrillation, supraventricular and ventricular extrasystoles. For statistical data analysis we used: Mann Whitney U test, Pirson’s2test, logistic regression and ROC curves. Results: The majority of patients were male (63.2%), older than 50 years and ASA status 1. The most of patients underwent throat surgery (38.2%). Intraoperative blood pressure variation and/or cardiac rhythm disturbances were present in 29.4% of patients. The highest incidence of intraoperative minor cardiac complications were in maxillofacial surgery (35.4%), then in ear surgery (35.1%), and the lowest incidence were in nose surgery (21.3%). Among all minor cardiac complications, the most frequent was bradycardia (20.5%), then hypertension (5.3%), tachycardia (4.7%), ventricular extrasystoles(0.5%),supraventricular extrasystoles(0.3%) and no new onset atrial fibrillation was registered. Logistic regression analysis idenified these risk factors: previous cardiac arrhythmia, anaesthesia suration, induced hypotension and ear surgery. Conclusion: Intraoperative blood pressure variation and cardiac rhythm disturbances, particularly bradycardia, are common in maxillofacial, ear, nose and throat surgery, especially in patients with previous cardiac arrhythmias and induced hypotension. The ear surgery and longer anaesthesia duration raise the risk for occurrence of intraoperative blood pressure variation and cardiac rhythm disturbances.

faktori rizika; maksilofacijalna i hirurgija uva, grla i nosa; hipertenzija; indukovana hipotenzija; poremećaji srčanog ritma

risk factors; maxillofacial, ear, nose and throat surgery; hypertension; induced hypotension; cardiac rhythm disturbances

616.1:616-089(043.3)

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