冠状动脉粥样硬化性心脏病支架植入患者术前评估和手术时机选择_West China Medical Journal

Authors：

 赵晓燕 ¹ , 王健 ¹ , 王廷华 ^1,2 ,  罗朝志 ¹

1. ;
2. ;

Corresponding author：

罗朝志, Email: chaozhil@aliyun.com

Keywords：

冠状动脉粥样硬化性心脏病; 支架内再狭窄; 围手术期; 麻醉; 球囊扩张术

DOI：

10.7507/1002-0179.201600428

Video：

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目的通过分析1例冠状动脉粥样硬化性心脏病（冠心病）支架植入患者的术前麻醉评估及手术时机选择等问题，总结该类患者的特点及相关文献的指导性意见，帮助医生作出正确的医疗决策。方法 1例老年男性患者，2012年3月行冠状动脉支架植入手术，2015年5月患者因结肠肿瘤需行限期结肠肿瘤根治术，术前发现患者冠状动脉支架内发生再狭窄。针对此患者的麻醉前评估及手术时机的选择等问题，检索相关文献，为该患者是否需要术前血管重建术以及如何进行手术时机的选择等问题寻找答案。结果结合相关文献及指南，对于有症状的冠心病患者应该积极处理，改善围手术期的心功能；但是，对于可疑恶性肿瘤的限期手术应适当放宽条件，不应一味按照指南延迟手术。结论正确的麻醉前评估和良好的围手术期管理是患者安全的重要保证，对于有可能变为急诊手术的限期手术，应考虑多种因素权衡利弊，尽可能在充分准备的前提下尽早完成。

Citation： 赵晓燕, 王健, 王廷华, 罗朝志. 冠状动脉粥样硬化性心脏病支架植入患者术前评估和手术时机选择. West China Medical Journal, 2016, 31(9): 1572-1574. doi: 10.7507/1002-0179.201600428 Copy

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19.	凌伟, 颜亚平, 李良月. 结直肠癌预后影响因素分析:附112例报告[J]. 中国普通外科杂志, 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. 陈晓敏, 沈南芬, 潘伟民, 等. 冠状动脉支架内再狭窄的特征与高压球囊治疗[J]. 浙江临床医学, 2000, 6:363-364.
14. 邓小明, 姚尚龙, 于布为, 等. 现代麻醉学[M]. 4版. 北京:人民卫生出版社, 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. 赖琳, 詹俊, 李楚强, 等. 大肠癌患者的临床、病理及预后分析576例[J]. 世界华人消化杂志, 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. 凌伟, 颜亚平, 李良月. 结直肠癌预后影响因素分析:附112例报告[J]. 中国普通外科杂志, 2007, 16(9):923-925.

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West China Medical Journal

冠状动脉粥样硬化性心脏病支架植入患者术前评估和手术时机选择

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