Objective: Perioperative myocardial infarction remains a severe complication in non-cardiac surgery and is one of the major causes of death. Cardiac troponin (cTn) I elevation is associated with short-term and long-term mortality. The aim of the study was to assess the proportion rate of cTnI elevation and its clinical characteristics among patients admitted for orthopaedic surgery with or without cardiovascular events. Methods: This is a retrospective study including 27 744 patients aged 50 years or older who admitted for orthopaedic surgery from 2009-2015 in Beijing Jishuitan Hospital. Results: Two hundred and sixty-five patients [age (71.7±9.9) years] had cTnI level> 0.04 μg/L with 66% (175 patients) of them being female. Among them, 59 patients were isolated troponin rise (ITR) (n=59), 13 were preoperative acute myocardial infarction (AMI), and 193 were postoperative AMI. The proportion of postoperative AMI was 0.69%. Those patients were more likely to have a history of coronary artery disease or hypertension. Non-ST-segment elevation myocardial infarction (NSTEMI) was more common (93.3%) than ST-segment elevation myocardial infarction in these patients. Most of them did not experience ischemic symptoms. Totally 76.7% of the AMI occurred within 3 days of surgery; and the in-hospital mortality rate was 10.4%. Conclusions: Perioperative elevation of troponin is common in patients undergoing orthopaedic surgery. Most postoperative AMI were NSTEMI and with absent or atypical ischemia symptoms. Monitoring troponin levels and electrocardiograph in at-risk patients is needed to find most of the AMI.
目的： 探讨骨科手术围手术期心肌肌钙蛋白I（cTnI）升高的发生率及临床特点。 方法： 回顾性分析2009—2015年在北京积水潭医院住院行骨科手术治疗、年龄≥50岁的27 744例患者，收集围手术期cTnI升高患者的临床资料。 结果： 265例(0.96%)患者围手术期发生cTnI升高（>0.04 μg/L），其年龄（71.7±9.9）岁，175例（66%）为女性。根据是否发生急性心肌梗死（AMI）以及AMI的发生时间将研究对象分为单纯cTnI升高（isolated troponin rise，ITR)组（59例），术前AMI组（13例），术后AMI组(193例)。术后AMI发生率为0.69%（193/27 744），术后AMI组患者多有冠心病、高血压等基础病病史，93.3%表现为非ST段抬高型心肌梗死（NSTEMI），大部分患者无心肌缺血症状或症状不典型，76.7%发生在术后3 d内，术后AMI患者住院期间病死率为10.4%。 结论： 骨科手术围手术期cTnI升高的现象并不少见，大部分患者缺乏典型的心肌缺血症状。有心血管危险因素的患者，围手术期应密切监测cTnI及心电图变化，以减少不良心脏事件的发生。.
Keywords: Orthopaedic surgery; Perioperative myocardial infarction; Troponin I.