80岁及以上患者冠状动脉CT造影后一周内非心脏手术的安全性

Safety study of octogenarian patients receiving non-cardiac surgery within 1 week after coronary computed tomographic angiography

目的探讨80岁及以上患者冠状动脉CTA检查后不同时间间隔行非心脏手术的安全性。方法回顾性调查福建医科大学附属协和医院≥80岁患者住院期间行冠状动脉CTA后实施非心脏手术的安全性，并根据冠状动脉CTA与手术的间隔时间分为两组，1组为冠状动脉CTA后1周内手术（73例），2组为冠状动脉CTA后1～3周内手术（35例）。比较两组患者的一般资料、手术前后血清肌酐（Scr）及估算肾小球滤过率（eGFR）变化、急性肾损伤（AKI）的发生率。所有研究对象根据改良心脏危险指数（RCRI）进行同手术期危险因素总和评分，并比较不同类型非心脏手术RCRI评分及安全性。结果共人选108例进行冠状动脉CTA，仅1例出现心悸和3例出现注射部位的疼痛反应，未发现其他不良反应；不同类型非心脏手术患者的RCRI评分均≤2分，冠状动脉CTA后进行手术未发现死亡病例；两组患者手术前后Scr水平及eGFR水平的变化差异无统计学意义（P〉0．05）。结论RCRI评分≤2分的80岁及以上高龄非心脏手术患者，术前冠状动脉CFA检查后1周内行非心脏手术是安全的。

Objective To compare the safety of octogenarian patients receiving non-cardiac surgery within 1 week versus within 1-3 weeks after coronary computed tomographic angiography（CTA）. Methods Octogenarian patients who underwent non-cardiac surgery after coronary CTA in Fujian Medical University Union Hospital, were retrospectively analyzed. All patients were divided into two groups： those received surgery within 1 week after coronary CTA as group 1 （n= 73）, those within 1-3 week after coronary CTA as group 2, （n= 35）. The baseline clinical characteristics,the changes in pre- and postoperative serum creatinine levels （Set）and estimated glomerular filtration rate（eGFR）,and the incidence of acute kidney injnry（AKI）were compared between two groups. The revised cardiac risk index（RCRI）score was evaluated for each octogenarian inpatient,and the RCRI sum score for differem types of non-cardiac surgery were calculated. Finally, the RCRI sum score of the preoperative risk factors were compared between different types of non-cardiac surgery so as to assess their specifically safety. Results In 108 patients who performed coronary CTA ,only one patients developed palpitation and three had injection site pain. All patients receiving different types of non-cardiac operation had low revised cardiac risk index（RCRI ≤ 2）. Death was not found. The serum levels of Scr and eGFR were similar between two groups before coronary CTA and after operation（all P〉0. 05）. Conclusions Octogenarian patients with low preoperative cardiac risk index（RCRI ≤ 2） are safe for performing non-cardiac surgery within 1 week after coronary CTA.