CTA判断冠状动脉粥样硬化对非心脏手术计划的影响及预测围手术期心脏风险事件的价值分析

CTA to Determine the Effect of Coronary Artery Atherosclerosis on Non Cardiac Surgical Planning and to Predict the Risk of Perioperative Cardiac Events

目的探讨CT冠状动脉造影(CTA)检查对于非心脏手术患者手术计划的影响及预测患者围手术期出现不良心血管事件的价值。方法选取在本院接受非心脏手术治疗且术前怀疑或已经确诊冠状动脉粥样硬化的患者116例,患者术前均进行CTA检查,根据患者是否进行如期手术分组,并探讨CTA检查结果对患者如其手术的影响作用,统计分析患者围手术期不良心血管事件发生率。结果本研究83例如期手术患者中,围手术期均未见严重的心血管不良事件发生,仅4例患者出现心动过速,未经特殊处理后自行恢复;比较如期手术组、推迟或放弃手术组患者的年龄、性别、吸烟史、BMI、合并疾病情况、心率比较差异均无统计学意义(P>0.05);冠脉中度、重度狭窄患者的如期手术率显著的低于轻度狭窄患者(P<0.05);冠脉重度狭窄患者的如期手术率显著的低于中度狭窄的患者(P<0.05);2支、3支冠脉狭窄患者的如期手术率显著的低于单支狭窄患者(P<0.05);3支冠脉狭窄患者的如期手术率显著的2支冠脉狭窄的患者(P<0.05)。结论对于非心脏手术患者,冠脉病变及其严重程度会对患者的手术计划产生影响,对于怀疑或确诊冠心病患者术前进行CTA检查并进行手术耐受评估具有较为重要的临床价值。

Objective To investigate the effect of CT coronary angiography （CTA） in patients with non cardiac surgery, and to predict the value of adverse cardiovascular events in the perioperative period. Methods Choose non-cardiac surgery in the hospital receiving treatment and preoperative patient has been diagnosed or suspected coronary atherosclerosis in 116 cases, preoperative underwent CTA examination, scheduled surgery patients grouped according to whether, and to explore the （＇TA examination results to the patient as it influence of surgery, statistical analysis perioperative adverse cardiovascular events, Results Choose to defer or forgo surgery, 33 patients （28.45%）, of which 11 cases of abandonment surgery, delayed surgery 22 cases, 83 cases scheduled surgery （71.55%）. This study 83 patients such as surgery, perioperative were no serious cardiowlscular adverse events, only four patients had tachycardia, without the self-healing after special treatment. Comparative scheduled surgery group, postpone or forgo surgery patients age, sex, smoking history, BMI, comorbidities situation, There was no significant difference in heart rate （P〉0.05）. CoronaW moderate, severe stenosis of tile scheduled surgery was significantly lower than the mild stenosis （P〈0.05）. Scheduled operation rate of severe coronaW artery stenosis in patients with significant less than moderate stenosis （P〈0.05）. 2 sticks, three patients with coronaW stenosis scheduled surgery was significantly lower than patients with single-vessel stenosis （P〈0.05）. 3-vessel coronaW artery stenosis in patients with scheduled surgery rate of two significant coronaty stenosis （P 〈0.05）. Conclusion For non-cardiac surgery coronary artery disease and the severity of the patient＇s surgical plan will have an impact, for the first suspected or confirmed coronary artery disease in patients undergoing surgery were CTA exanlination and assess tolerance has more important clinical value.