负荷超声对非心脏开胸手术心脏风险性评估的初步研究

Dobutamine stress echocardiography for the preoperative cardiac risk assessment in patients undergoing non-cardiac thoracic surgery

目的评价多巴酚丁胺负荷超声(DSE)在预测非心脏开胸手术患者心脏风险性方面的应用价值。方法从肺、食道肿瘤患者中选择具有冠心病的易患因素或有心肌缺血表现者共33例,于开胸手术前行多巴酚丁胺负荷超声(DsE)检查,DSW阳性者再行冠脉造影,开胸手术中及术后早期均予心电监护等,并详细记录术后经过及各种并发症。结果 32例顺利完成了DSE试验,检查过程中除一过性的早搏等心律失常外无严重并发症发生,30例结果为阴性,2例结果阳性,均系高龄女性(65岁及70岁)食管癌患者。随后的冠脉造影显示与DSE结果相对应的冠脉狭窄病变。29例患者接受了开胸手术,术后出现各种心律失常者8例、但均非在DSE 试验中出现房、室性早搏者。术中及术后无心肌缺血及其他严重的心血管并发症,无手术死亡发生。4例未行开胸手术,2例系DSE阳性者自动放弃手术改行放疗,2例为阴性者因肺功能极差不具备手术条件。结论 DSE能准确评估非心脏胸部手术患者的心血管风险,具有较高的阴性预测值,对食道等具有高风险术式的高龄患者尤应加强术前心脏的评估,但对术后心律失常的发生无预测价值。

Objective To evaluate the value of Dobutamine stress eehocardiography （DSE） in predicting preoperatively cardiac risk in non-cardiac thoracic surgery. Methods Thirty-three patients choosed from patients with lung or esophageal cancers who had symptoms of myocardial ischaemia or risk factors for coronary heart diseases underwent DSE less than one week before thoracic surgery. Coronary angiography was performed if DSE results were positive. Major cardiac events were recorded during and after the operation. Results DSE was accomplished in 32 out of 33 cases. There was no significant adverse events during the test except transient arrhythmias. Two patients who had positive DSE were elder （65 and 70 years old, respectively） females with esophageal cancer. Subsequently coronary angiography confirmed the stenofic lesions corresponding to DSE results. Of 29 cases receiving thoracic surgery, 8 had variant arrhythmias after surgery, whereas none of them had arrhythmias during DSE. No major events including acute myocardial ischemia or death occurred in the perioperative period. Thoracic operation was cancelled in 4 patients due to positive DSE（2 patients） and poor lung function（2 patients）. Conclusion DSE can assess the cardiac risks preoperatively in non-cardiac thoracic surgery with high negative predictive value. DSE is necessary for elder patients with esophageal cancer, however, it has no predictive value for perioperative arrhythmia.