多巴酚丁胺负荷超声心动图评价老年患者胸部手术的心血管风险

Evaluation of Cardiovascular Risk for Non-Cardiac Thoracic Surgery in Elderly Patients with Dobutamine Stress Echocardiography.

目的探讨多巴酚丁胺负荷超声心动图试验对老年患者非心脏开胸手术(non-cardiac thoracic surgery,NCTS)后心血管风险的评估作用,以提高手术疗效、降低手术风险。方法对32例65岁以上老年患者行多巴酚丁胺负荷超声心动图试验,阳性者进一步行冠状动脉造影检查,阴性者记录术后经过及各种并发症发生情况。结果试验过程中出现偶发房性早搏及/或室性早搏5例,无严重并发症发生。2例因持续心房颤动无法评判心室收缩活动,余30例完成多巴酚丁胺负荷试验;2例(6.7%,2/30)阳性患者经冠状动脉造影证实有对应部位冠脉严重阻塞取消手术,2例可疑阳性。28例接受开胸手术,术后共发生并发症18例,其中心肺并发症13例(46.4%,13/28),心律失常发生率最高(28.6%,8/28),2例可疑阳性者中1例术后第5d发生心绞痛。多巴酚丁胺负荷试验对术后心血管风险的阴性预测值达100%。结论多巴酚丁胺负荷超声心动图试验安全可行,能准确地评估有心血管合并症行老年胸部手术患者的心血管风险,但对术后心律失常的发生无预测价值。

Objective To evaluate the cardiovascular risk for non-cardiac thoracic surgery （NCTS） in elderly patients with dobutamine stress echocardiography and to decrease surgical risk for NCTS in the geriatrics. Methods Dobutamine stress echocardiography was used for cardiovascular evaluation in 32 NCTS candidates aged over 65 years. Patients with positive echocardiography underwent coronary angiography. Postoperative course and all complications were carefully recorded for the study. Results No serious cardiovascular events occurred during the test except for atrial or ventricular premature contracts in 5 cases. In 2 patients （6.7%,2/30） dobutamine test was positive and coronary artery occlusion was proved by further angiography. Thoracotomy was performed in 28 cases, including 2 cases with dubious result at dobutamine test. Cardiopulmonary complications occurred in 13 patients （46.4%,13/28） after surgery. Supraventricular tachyarrhythmia was the most common complication, occurred in 8 patients （28.6%,8/28）. One of the 2 patients with dubious result at dobutamine test developed definitive angina in the 5th postoperative day. The negative predictive value of dobutamine test was 100%. Conclusion Dobutamine stress echocardiography is a safe and effective method to evaluate major cardiovascular risk of NCTS in the geriatrics. But it is not predictive of tachyarrhythmia after surgery.