2021 年第 12 期 第 16 卷

冠状动脉造影对非心脏手术围术期心血管风险评估的价值

Value of coronary angiography in evaluating perioperative cardiovascular risk for patients undergoing non-cardiac surgery

作者：王继红1郝小龙2郑梅1胡文兰1 赵兴山1

英文作者：Wang Jihong1 Hao Xiaolong2 Zheng Mei1 Hu Wenlan1 Zhao Xingshan1

单位：1北京积水潭医院心内科100035；2北京市监狱管理局清河分局医院内科100481

英文单位：1Department of Cardiology Beijing Jishuitan Hospital Beijing 100035 China; 2Department of Internal Medicine Qinghe Branch Hospital of Beijing Municipal Administration of Prison Beijing 100481 China

关键词：心血管风险；冠状动脉造影；非心脏手术；围术期

英文关键词：Cardiovascularrisk;Coronaryangiography;Non-cardiacsurgery;Preoperativeperiod

• 摘要：

• 目的 探讨冠状动脉造影（CAG）对非心脏手术围术期心血管风险评估的价值。方法 收集2013年1月1日至2015年12月31日于北京积水潭医院拟行非心脏手术并于术前完善CAG检查的住院患者的临床资料行回顾性分析。依据是否如期行非心脏手术，分为手术组（144例）和未手术组（74例），比较2组临床特点和CAG检查结果。分析CAG检查结果对非心脏手术计划、术后出现心脏不良事件的影响。结果  手术组男性、合并高血压病、冠心病（冠状动脉粥样硬化性心脏病）、糖尿病的比例低于未手术组，差异均有统计学意义（均P＜0.01）。218例患者经CAG确诊冠心病164例（75.2%）。CAG结果显示：未见明显病变或轻微病变54例（24.8%），单支病变68例（31.2%），双支病变42例（19.3%），三支病变54例（24.8%）。未手术组三支病变占比最高［37例（50.0%）］，而手术组占比较高的则是无明显病变或轻微病变及单支病变［无明显病变或轻微病变51例（35.4%）、单支病变53例（36.8%）］，2组冠状动脉病变支数差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示性别、冠心病、糖尿病与是否如期手术明显相关（均P<0.05）。术后21例(18.1%)患者出现心脏不良事件，15例出现心肌梗死患者中7例为三支病变。结论  本研究经CAG确诊的冠心病患者占研究对象的半数以上，大部分合并高血压病和糖尿病。冠状动脉多支病变更容易影响手术计划，术后更易出现心脏事件。冠状动脉病变支数对手术计划和术后心脏事件发生率有影响。

• Objective To explore the value of coronary angiography(CAG) in evaluating perioperative cardiovascular risk for patients undergoing non-cardiac surgery. Methods Clinical data of patients who underwent non-cardiac surgery and preoperative CAG detection in Beijing Jishuitan Hospital were retrospectively analyzed from January 1, 2013 to December 31, 2015. Patients were divided into surgery group (144 cases) and non-surgery group (74 cases) according to whether scheduled non-cardiac surgery. The clinical characteristics and CAG results were compared between the two groups . The influence of CAG results on the plan of the surgery and the adverse cardiovascular events after surgery was analyzed. Results Rates of male, hypertension, coronary atherosclerotic heart disease (CHD) and diabetes mellitus in surgery group were lower than those in non-surgery group (all P<0.01). There were 218 cases underwent CAG and 164 cases (75.2%) were diagnosed as CHD. CAG detection showed that there were 54 cases (24.8%) with no obvious lesion or slight lesion, 68 cases (31.2%) with single vessel lesion, 42 cases (19.3%) with double vessel lesions and 54 cases (24.8%) with triple vessel lesions. The rate of triple vessel lesions was the highest in non-surgery group［37 cases(50.0%)］, while the rates of no obvious lesion or slight lesion and single vessel lesion were high in surgery group ［51 cases(35.4%) with no obvious lesion or slight lesion, 53 cases (36.8%) with single vessel lesion］. There was significant difference in numbers of coronary artery lesion between the two groups (P<0.05). Multivariate Logistic regression analysis showed that gender, CHD and diabetes mellitus were significantly correlated to whether the surgery was performed as scheduled (all P<0.05). There were 21 cases (18.1%) who had adverse cardiovascular events after the surgery. Among 15 cases with myocardial infarction, 7 cases had triple vessel lesions. Conclusions   More than half of the patients had CHD diagnosed by CAG. Most of them were complicated with hypertension and diabetes mellitus. The coronary artery multi vessel lesion is easy to affect the surgical plan, and postoperative cardiac events are more likely to occur. The number of coronary artery lesion has effects on the surgical plan and the incidence of postoperative cardiac events.