CAJ | 학술논문

背景近三十年来,心脏冠脉支架患者日益增多,此类患者在接受非心脏手术时其围手术期将面临特殊挑战.目的现将重点讨论支架血栓的病理生理以及冠脉支架患者非心脏手术围手术期的处理策略.内容冠脉支架患者为预防支架内血栓的发生,通常接受由阿司匹林和氯吡格雷为主要药物的双联抗血小板治疗,其疗程为裸金属支架bare metal stent,BMS)4周～6周,药物洗脱支架(drug eluting,DES)至少1年,冠脉支架患者,尤其是DES患者,临床医生必须审慎权衡,终止抗血小板治疗意味增加围手术期支架内血栓、心肌梗死和心源性死亡的危险;而连续抗血小板治疗则可能增加手术出血的危险.趋向目前比较一致的观点是围手术期心脏并发症的危险远大于出血危险,因此,除颅内和眼球等闭合腔隙手术外,围手术期应尽可能维持抗血小板治疗.
배경 근삼십년래,심장관맥지가환자일익증다,차류환자재접수비심장수술시기위수술기장면림특수도전.목적 현장중점토론지가혈전적병리생리이급관맥지가환자비심장수술위수술기적처리책략.내용 관맥지가환자위예방지가내혈전적발생,통상접수유아사필림화록필격뢰위주요약물적쌍련항혈소판치료,기료정위라금속지가bare metal stent,BMS)4주～6주,약물세탈지가(drug eluting,DES)지소1년,관맥지가환자,우기시DES환자,림상의생필수심신권형,종지항혈소판치료의미증가위수술기지가내혈전、심기경사화심원성사망적위험;이련속항혈소판치료칙가능증가수술출혈적위험.추향 목전비교일치적관점시위수술기심장병발증적위험원대우출혈위험,인차,제로내화안구등폐합강극수술외,위수술기응진가능유지항혈소판치료.
Background The number of patients with coronary stents has increased rapidly over the last three decades. When those patients subsequently present for non-cardiac surgery,they will be posed a particular challenge during perioperative period.Objective This review discusses the pathophysiology of coronary stent thrombosis,and perioperative management strategies for patients with coronary stents undergoing non-cardiac surgery.Content In order to prevent stent thrombosis,patients need to receive dual anti-platelet therapy(generally aspirin combined with clopidogrel) for four to six weeks with bare-metal stents(BMS),or at least one year with drug-eluting stents (DES) after stents are implanted. Faced with patients with coronary stents,particularly DES,clinicians must carefully balance the risks of discontinuing and continuing anti-platelet drugs. The former means to increase the possibility of perioperative stent thrombosis,MI,and cardiac death,while the latter will lead to potential surgical bleeding,which in certain cases may be life-threatening.Trend It comes into a consensus that the risk of cardiac complications exceeds that of bleeding. Therefore,maintenance of dual anti-platelet therapy perioperatively is recommended,except those surgeries in closed cavities,e.g.,intracranial or intraocular surgeries.