CAJ | 학술논문

目的探讨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.方法回顾性分析解放军总医院2008年11月至2010年11月拟行非心脏外科手术,术前怀疑或确诊冠心病而行冠状动脉CTA患者89例,男56例、女33例,平均年龄65.1岁；CTA评价冠状动脉粥样硬化管腔狭窄和钙化积分情况；分析放弃或推迟手术原因、CT结果对手术计划的影响；统计围手术期心血管事件发生情况、判断冠状动脉粥样硬化与心血管事件的相关性.结果 89例中,10例未见冠状动脉粥样硬化征象(11.24％)；75例发现粥样硬化(84.27％)；2例冠脉搭桥术后、2例PCI支架置入术后；参考冠脉CTA结果,12例放弃手术(13.48％),8例干预后择期手术(8.99％)；冠脉管腔重度狭窄对手术计划有明显影响(P=0.003)；钙化积分程度对手术计划没有明显影响(P=0.190)；如期或冠心病干预后进行手术者,1例术后出现房颤.结论非心脏手术前怀疑冠心病者,冠状动脉CTA所提示的结果明显影响手术计划；经冠状动脉CTA检查,有助于降低围手术期心血管事件.
목적 탐토CTA판단관상동맥죽양경화대비심장수술계화적영향급예측위수술기심장풍험사건적개치.방법 회고성분석해방군총의원2008년11월지2010년11월의행비심장외과수술,술전부의혹학진관심병이행관상동맥CTA환자89례,남56례、녀33례,평균년령65.1세；CTA평개관상동맥죽양경화관강협착화개화적분정황；분석방기혹추지수술원인、CT결과대수술계화적영향；통계위수술기심혈관사건발생정황、판단관상동맥죽양경화여심혈관사건적상관성.결과 89례중,10례미견관상동맥죽양경화정상(11.24％)；75례발현죽양경화(84.27％)；2례관맥탑교술후、2례PCI지가치입술후；삼고관맥CTA결과,12례방기수술(13.48％),8례간예후택기수술(8.99％)；관맥관강중도협착대수술계화유명현영향(P=0.003)；개화적분정도대수술계화몰유명현영향(P=0.190)；여기혹관심병간예후진행수술자,1례술후출현방전.결론 비심장수술전부의관심병자,관상동맥CTA소제시적결과명현영향수술계화；경관상동맥CTA검사,유조우강저위수술기심혈관사건.
Objective To explore the values of detecting coronary atherosclerosis by computed tomography angiogram (CTA) on non-cardiac surgery planning and cardiac risk assessment of coronary atherosclerosis during perioperative period.Methods A total of 89 patients with suspected coronary heart disease (CHD) scheduled for non-cardiac surgery underwent coronary CTA to evaluate luminal stenosis and calculate calcification score.There were 56 males and 33 females with a mean age of 65.1 years.Operative sites included chests (n =29),abdomens and pelvis (n =26),large vessels (n =3),bones and joints (n =19) and other regions (n =12).Reasons of abandoned or postponed surgery were documented to analyze the influence of CTA results on surgery planning.Cardiac events were recorded to assess the correlation with coronary atherosclerosis.Results Among them,75 patients (84.27％) were diagnosed as atherosclerosis while 10 patients (11.24％) were negative; 2 patients had coronary artery bypass and another 2 had stent implantation.According to the results of CTA,12 operations (13.48％) were canceled and 8 (8.98％) postponed after interventions.Severe stenosis of coronary lumen had significant effects on surgery planning (P =0.003) while calcification score did not.In patients undergoing surgery as scheduled or after intervention,1 had atrial fibrillation at post-operation.Conclusion For the patients with suspected CHD scheduled for non-cardiac surgery,severity of coronary stenosis may greatly influence surgery planning.Preoperative coronary CTA may decrease the incidence of cardiac events during perioperative period.