Faktori rizika za pojavu intraoperativnih hemodinamskih poremećaja kod bolesnika podvrgnutih hirurškom lečenju štitaste žlezde

Abstract

Uvod: Cilj rada je da odredi učestalost i faktore rizika za pojavu intraoperativnih hemodianmskih poremećaja kod bolesnika sa komorbiditetima pobrgnutih hirurškom lečenju oboljenja štitaste žlezde. Metodologija: ovo je kohortna studija, u kojoj su uključena 1252 eutireoidna bolesnika ASA 2 i ASA 3 statusa. Ispitivani su sledeći faktori rizika: pol, godine života, indeks telesne mase, ASA status, prijemna dijagnoza, vrsta hirurške intervencije, dužina trajanja operacije, vreme provedeno pod anestezijom, učestalost otežane intubacije traheje i sledeći komorbiditeti: hipertenzija, kardiomiopatija, poremećaji srčanog ritma, angina pektoris-ishemijska bolest srca, dijebetes melitus, bubrežne bolesti. Registrovani su sledeći intraoperativni poremećaji: hipertenzija, hipertenzivna kriza, hipotenzija i poremećaji srčanog ritma (tahikrdija, bradikardija, novonastala intraoperativna atrijalna fibrilacija i ekstrasistole). Za statističku obradu korišćen je Pirsonov Hi kvadrat test, univarijantna i multivarijantna logistička regresiona analizu. Rezultati: većinu bolesnika su činile žene (86.3%). Intraoperativni hemodinamski poremećaji su registrovani kod 903 (72.1%) bolesnika. Najčesšći intraoperativni poremećaj je bila hipertenzija, registrovana kod 61.4% bolesnika, zatim poremećaji srčanog ritma kod 27.9% bolesnika, hipotenzija kod 6.5% bolesnika i hipertenzivna kriza kod 3.1% bolesnika. Univarijanta analiza je registrovala sledeće faktore rizika: starije životno doba, ASA 3 status, BMI >25kg/m², trajanje operacije, vreme provedeno pod anestezijom, hipertenzija, kadriomiopatija, vrsta kardiomiopatije. Multivarijantna regiresiona analiza je pokazala da su nezavisni prediktori pojave IOHP: godine starosti, hipertenzija i kardiomiopatija. Zaključak: Intraoperativni hemodinamski poremećaji su česti tokom tireoidne hirurgije, pre svega intraoperativna hipertenzija. Starije životno doba, hipertenzija i kardiomiopatija kao koegzistirajuće bolesti su nezavisni faktori rizika za pojavu IOHP.

Background: The aim of study was to determine the incidence and risk factors for intraoperative cardiovascular complications in thyroid surgery patients with comorbidities. Methods: This prospective study included 1252 euthyroid patients with ASA 2 and ASA 3 status who underwent thyroid surgery. The following risk factors were examined: gender, age, body mass index (BMI), ASA status, admission diagnoses, type of operation, length of surgery, time under general anesthesia, difficult intubation of trachea and coexisting diseases: hypertension, cardiomyopathy (CMP), cardiac arrhythmias, angina pectoris, diabetes mellitus (DM), kidney disease. Following intraoperative complications were recorded: hypertension, hypotension, hypertensive crisis and cardiac arrhythmias (tachycardia, bradycardia, arrhythmia absoluta and extrasystole). We used Pearson chi-square test, univariate and multivariate logistic regression for statistic analysis. Results: The majority of patients were female (86.3%). In 903 (72.1%) patients IOCVC were detected. The most common complication was intraoperative hypertension 61.4%, then heart rhythm disturbances in 27.9% patients, hypotension in 6.5% and hypertensive crysis in 3.1% patients. Eight risk factors for IOCVC were registred by univariante analysis: advanced age, ASA 3 status, BMI >25kg/m², length of surgery, time under general anaesthesia, and hypertension, cardiomyopathy and thy type of cardiomyopathy as coexisting disease. The multivariate regression model identified tree independent predictors for IOCVC: age, hypertension and cardiomyopathy. Conclusion: Intraoperative cardiovascular complications are common in thyroid surgery. The most common is intraoperative hypertension. Older age, hypertension and cardiomyopathy as a coexisting disease are independent risk factors for IOCVC.