冠狀動脈粥樣硬化性心臟病支架植入患者術前評估和手術時機選擇_West China Medical Journal

Authors：

 趙曉燕 ¹ , 王健 ¹ , 王廷華 ^1,2 ,  羅朝志 ¹

1. ;
2. ;

Corresponding?author：

羅朝志, Email: chaozhil@aliyun.com

Keywords：

冠狀動脈粥樣硬化性心臟病; 支架內再狹窄; 圍手術期; 麻醉; 球囊擴張術

DOI：

10.7507/1002-0179.201600428

Video：

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目的通過分析1例冠狀動脈粥樣硬化性心臟病（冠心病）支架植入患者的術前麻醉評估及手術時機選擇等問題，總結該類患者的特點及相關文獻的指導性意見，幫助醫生作出正確的醫療決策。方法 1例老年男性患者，2012年3月行冠狀動脈支架植入手術，2015年5月患者因結腸腫瘤需行限期結腸腫瘤根治術，術前發現患者冠狀動脈支架內發生再狹窄。針對此患者的麻醉前評估及手術時機的選擇等問題，檢索相關文獻，為該患者是否需要術前血管重建術以及如何進行手術時機的選擇等問題尋找答案。結果結合相關文獻及指南，對于有癥狀的冠心病患者應該積極處理，改善圍手術期的心功能；但是，對于可疑惡性腫瘤的限期手術應適當放寬條件，不應一味按照指南延遲手術。結論正確的麻醉前評估和良好的圍手術期管理是患者安全的重要保證，對于有可能變為急診手術的限期手術，應考慮多種因素權衡利弊，盡可能在充分準備的前提下盡早完成。

Citation： 趙曉燕, 王健, 王廷華, 羅朝志. 冠狀動脈粥樣硬化性心臟病支架植入患者術前評估和手術時機選擇. West China Medical Journal, 2016, 31(9): 1572-1574. doi: 10.7507/1002-0179.201600428 Copy

1.	Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA guidelines on non-cardiac surgery:cardiovascular assessment and management:the joint task force on non-cardiac surgery:cardiovascular assessment and management of the European society of cardiology (ESC) and the European society of anaesthesiology (ESA)[J]. Eur J Anaesthesiol, 2014, 31(10):517-573.
2.	Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery:brain natriuretic peptide in 1590 patients[J]. Heart, 2006, 92(11):1645-1650.
3.	Rodseth RN, Padayachee L, Biccard BM. A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients[J]. Anaesthesia, 2008, 63(11):1226-1233.
4.	Karthikeyan G, Moncur RA, Levine O, et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an Independent predictor of adverse cardiovascular outcomes within 30 days of non-cardiac surgery?A systematic review and meta-analysis of observational studies[J]. J Am Coll Cardiol, 2009(54):1599-1606.
5.	Guarracino F, Baldassarri R, Priebe HJ. Revised ESC/ESA guidelines on non-cardiac surgery:cardiovascular assessment and management. implications for preoperative clinical evaluation[J]. Minerva Anestesiol, 2015, 81(2):226-233.
6.	Fernando A, Pérez-Vizcayno JM, Alberto C, et al. A prospective randomized trial of Drug-Eluting balloons versus Everolimus-Eluting stents in patients with In-Stent restenosis of Drug-Eluting stents[J]. Am Coll Cardiol, 2015, 66(1):23-33.
7.	Alfonso F, Byrne RA, Rivero FA. Current treatment of In-Stent restenosis[J]. J Am Coll Cardiol, 2014, 63(24):2659-2673.
8.	Dangas GD, Claessen BE, Caixeta AA, et al. In-Stent restenosis in the Drug-Eluting stent era[J]. J Am Coll Cardiol, 2010, 56(23):1897-1907.
9.	Kufner S, Cassese S, Valeskini M, et al. Long-term efficacy and safety of paclitaxel-eluting balloon for the treatment of drug-eluting stent restenosis:3-year results of a randomized controlled trial[J]. JACC Cardiovasc Interv, 2015, 8(7):877-884.
10.	Steinberg DH, Gaglia MA, Pinto Slottow TL, et al. Outcome differences with the use of drug-eluting stents for the treatment of in-stent restenosis of bare-metal stents versus drug-eluting stents[J]. Am J Cardiol, 2009, 103(4):491-495.
11.	Byrne RA, Cassese S, Windisch T, et al. Differential relative efficacy between drug-eluting stents in patients with bare metal and drug-eluting stent restenosis; evidence in support of drug resistance:insights from the ISAR-DESIRE and ISAR-DESIRE 2 trials[J]. EuroIntervention, 2013, 9(7):797-802.
12.	Alfonso F, Zueco J, Cequier A, et al. A randomized comparison of repeat stenting with balloon angioplasty in patients with in-stent restenosis[J]. J Am Coll Cardiol, 2003, 42(5):796-805.
13.	陳曉敏, 沈南芬, 潘偉民, 等. 冠狀動脈支架內再狹窄的特征與高壓球囊治療[J]. 浙江臨床醫學, 2000, 6:363-364.
14.	鄧小明, 姚尚龍, 于布為, 等. 現代麻醉學[M]. 4版. 北京:人民衛生出版社, 2014.
15.	Brilakis ES, Orford JL, Fasseas P, et al. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery[J]. Am J Cardiol, 2005, 96(4):512-514.
16.	Huber KC, Evans MA, Bresnahan JF, et al. Outcome of noncardiac operations in patients with severe coronary artery disease successfully treated preoperatively with coronary angioplasty[J]. Mayo Clinic Proceedings, 1992, 67(1):15-21.
17.	賴琳, 詹俊, 李楚強, 等. 大腸癌患者的臨床、病理及預后分析576例[J]. 世界華人消化雜志, 2007, 15(9):1037-1040.
18.	Wattacheril J, Kramer JR, Richardson P, et al. Lagtimes in diagnosis and treatment of colorectal cancer:determinants and association with cancer stage and survival[J]. Aliment Pharmacol Ther, 2008, 28(9):1166-1174.
19.	凌偉, 顏亞平, 李良月. 結直腸癌預后影響因素分析:附112例報告[J]. 中國普通外科雜志, 2007, 16(9):923-925.

1. Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA guidelines on non-cardiac surgery:cardiovascular assessment and management:the joint task force on non-cardiac surgery:cardiovascular assessment and management of the European society of cardiology (ESC) and the European society of anaesthesiology (ESA)[J]. Eur J Anaesthesiol, 2014, 31(10):517-573.
2. Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery:brain natriuretic peptide in 1590 patients[J]. Heart, 2006, 92(11):1645-1650.
3. Rodseth RN, Padayachee L, Biccard BM. A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients[J]. Anaesthesia, 2008, 63(11):1226-1233.
4. Karthikeyan G, Moncur RA, Levine O, et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an Independent predictor of adverse cardiovascular outcomes within 30 days of non-cardiac surgery?A systematic review and meta-analysis of observational studies[J]. J Am Coll Cardiol, 2009(54):1599-1606.
5. Guarracino F, Baldassarri R, Priebe HJ. Revised ESC/ESA guidelines on non-cardiac surgery:cardiovascular assessment and management. implications for preoperative clinical evaluation[J]. Minerva Anestesiol, 2015, 81(2):226-233.
6. Fernando A, Pérez-Vizcayno JM, Alberto C, et al. A prospective randomized trial of Drug-Eluting balloons versus Everolimus-Eluting stents in patients with In-Stent restenosis of Drug-Eluting stents[J]. Am Coll Cardiol, 2015, 66(1):23-33.
7. Alfonso F, Byrne RA, Rivero FA. Current treatment of In-Stent restenosis[J]. J Am Coll Cardiol, 2014, 63(24):2659-2673.
8. Dangas GD, Claessen BE, Caixeta AA, et al. In-Stent restenosis in the Drug-Eluting stent era[J]. J Am Coll Cardiol, 2010, 56(23):1897-1907.
9. Kufner S, Cassese S, Valeskini M, et al. Long-term efficacy and safety of paclitaxel-eluting balloon for the treatment of drug-eluting stent restenosis:3-year results of a randomized controlled trial[J]. JACC Cardiovasc Interv, 2015, 8(7):877-884.
10. Steinberg DH, Gaglia MA, Pinto Slottow TL, et al. Outcome differences with the use of drug-eluting stents for the treatment of in-stent restenosis of bare-metal stents versus drug-eluting stents[J]. Am J Cardiol, 2009, 103(4):491-495.
11. Byrne RA, Cassese S, Windisch T, et al. Differential relative efficacy between drug-eluting stents in patients with bare metal and drug-eluting stent restenosis; evidence in support of drug resistance:insights from the ISAR-DESIRE and ISAR-DESIRE 2 trials[J]. EuroIntervention, 2013, 9(7):797-802.
12. Alfonso F, Zueco J, Cequier A, et al. A randomized comparison of repeat stenting with balloon angioplasty in patients with in-stent restenosis[J]. J Am Coll Cardiol, 2003, 42(5):796-805.
13. 陳曉敏, 沈南芬, 潘偉民, 等. 冠狀動脈支架內再狹窄的特征與高壓球囊治療[J]. 浙江臨床醫學, 2000, 6:363-364.
14. 鄧小明, 姚尚龍, 于布為, 等. 現代麻醉學[M]. 4版. 北京:人民衛生出版社, 2014.
15. Brilakis ES, Orford JL, Fasseas P, et al. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery[J]. Am J Cardiol, 2005, 96(4):512-514.
16. Huber KC, Evans MA, Bresnahan JF, et al. Outcome of noncardiac operations in patients with severe coronary artery disease successfully treated preoperatively with coronary angioplasty[J]. Mayo Clinic Proceedings, 1992, 67(1):15-21.
17. 賴琳, 詹俊, 李楚強, 等. 大腸癌患者的臨床、病理及預后分析576例[J]. 世界華人消化雜志, 2007, 15(9):1037-1040.
18. Wattacheril J, Kramer JR, Richardson P, et al. Lagtimes in diagnosis and treatment of colorectal cancer:determinants and association with cancer stage and survival[J]. Aliment Pharmacol Ther, 2008, 28(9):1166-1174.
19. 凌偉, 顏亞平, 李良月. 結直腸癌預后影響因素分析:附112例報告[J]. 中國普通外科雜志, 2007, 16(9):923-925.

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West China Medical Journal

冠狀動脈粥樣硬化性心臟病支架植入患者術前評估和手術時機選擇

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