Gensini评分对非心脏手术前评估的应用价值

Value of gensini score on preoperative cardiac risk assessment for patients undergoing non-cardiac surgery

目的:探讨Gensini评分对非心脏手术围手术期心血管缺血评估的价值。方法:回顾性分析2013年1月1日至2015年12月31日在我院住院拟行非心脏手术,并于术前完善冠状动脉造影检查的患者。依据是否如期行非心脏手术,分为手术组(144例)和非手术组(74例),比较两组临床特点,通过Gensini评分系统将冠状动脉造影结果分为四个层面,分析Gensini分层对手术计划、非心脏手术后出现心脏不良事件的影响。结果:研究期间非心脏手术患者术前行冠状动脉造影检查共218人,经冠状动脉造影检查确诊冠心病164例。手术组Gensini评分1~4组中的比例分别占90.7%、77.1%、62.5%、50.7%,非手术组分别占9.3%、22.9%、37.5%、49.3%(P<0.05)。Gensini评分分组1~4组中心脏不良事件发生率分别占28.6%、14.3%、9.5%、47.6%(P<0.05)。结论:经冠状动脉造影确诊的冠心病占半数以上,大部分合并高血压和糖尿病。Gensini评分分层高组容易影响手术计划,且术后心脏事件发生率较高。

Objective:To explore the value of Gensini score in the assessment of perioperative cardiovascular risk.Methods:This was a retrospective study which enrolled patients who were scheduled for non-cardiac surgery in Beijing Jishuitan Hospital during January 2013 to December 31 in 2015.The preoperative CAG examinations were performed and the images of CAG were analyzed in all patients.The clinical and angiographic characteristics between two groups including the operation group(144 patients)and non-operation group(74 patients)were compared,based on the CAG derived Gensini score,four groups were divided to explore the effect of Gensini score on the surgical plan and the major adverse cardiovascular events.Results:218 patients who underwent preoperative CAG examination were enrolled,including 95 men(43.5%).After the CAGexamination,164 patients were diagnosed with coronary heart disease(CHD).144 patients(66.1%)received surgical operation as the scheduled plan.The operation were more likely to be delayed or cancelled in the patients with higher Gensini score not only in the operation group(1~4 groups with the increase of Gensini score::90.7%,77.1%,62.5%,50.7%,but also in the non-operation group(1-4 groups with the Gensini score increase:9.3%,22.86%,37.5%,49.3%,P<0.05).Furthermore,patients with higher Gensini score were more likely to have postoperative adverse cardiac events during perioperative period.Conclusions:More than half of the patients enrolled in our study had coronary artery disease diagnosed by CAG.Most of them were complicated with hypertension and diabetes mellitus.Patients with higher Gensini score were more likely to have postoperative cardiac events after surgery,suggesting that it may be necessary to perform the CAG examination to identify higher risk of patients,thus preventing from the cardiovascular events.