冠状动脉CT造影指标对老年中或高危险度非心脏手术计划的影响

目的:探讨冠状动脉CT造影(CCTA)指标对老年中高危险度非心脏手术计划的影响。方法:回顾性分析我院2012年1月到2013年12月,连续入组的非心脏手术术前怀疑冠心病而行CCTA的患者冠状动脉粥样硬化特征资料,包括冠状动脉狭窄的严重程度(MSS)、冠状动脉粥样硬化病变累及支数(N)、节段累及积分(SIS)、节段狭窄积分(SSS);记录推迟或放弃手术的原因、分析CCTA结果对非心脏手术计划的影响。应用Logistic回归分析患者冠状动脉MSS、N、SIS及SSS与非心脏手术计划改变之间的关系,计算优势比(OR),作受试者工作特征曲线(ROC)并计算曲线下面积。结果:本研究共398例患者,其中76例(19.1%)冠状动脉无异常表现;220例(55.3%)表现为轻度冠状动脉粥样硬化征象;102例(25.6%)显示重度冠状动脉粥样硬化征象;参考CCTA结果,340例(85.4%)患者如期进行了手术,26例(6.5%)患者干预后择期进行手术,32例(9.2%)放弃手术;Logistic回归分析表明:个体冠心病的MSS、N、SIS及SSS是老年非心脏手术计划改变的危险因素,OR值分别为:2.07,2.89,1.17及1.16(均P0.05)。个体冠心病的MSS、N、SIS及SSS的ROC曲线下面积依次为:0.613,0.615及0.624,0.648,SIS及SSS的最佳截断点分别为3.50和3.50。结论:应用CCTA评价术前怀疑冠心病的老年中高危险度非心脏手术患者,冠状动脉粥样硬化指标均会影响手术计划。

Influence on plan of non-cardiac surgery at intermediate or high risk degree in elder patients by CT angiography detecting coronary atherosclerosis disease before non-cardiac surgery

Objective: To investigate the influence on Plan of Non-cardiac Surgery at intermediate or high risk degree in elderly patients by computed tomographic angiography detecting coronary atherosclerosis disease( CAD) before Non-cardiac Surgery. Methods: We retrospectively reviewed the clinical characteristics and CCTA data( Per-patient maximal stenosis severity,Per-vessel CAD severity was dened coronary atherosclerosis in zero,one,two,or three coronary artery vessels,segment involvement score( SIS),segment stenosis score( SSS) of elderly patients with suspected coronary heart disease( CHD) planning to receive non-cardiac surgery at intermediate or high risk degree. Reasons of abandoned or postponed surgery were write down so as to analyze the influence of CCTA results on surgery planning. Results: In 398 patients,322( 80. 9%) patients[220( 55.3%) nonobstructive,102( 25.6%) obstructive]were diagnosed as atherosclerosis while 76 patients( 19.1%) were normal; According to the results of CCTA,32 surgery( 8.1%) were canceled,and 26( 6.5%) were postponed. Per-patient maximal stenosis severity,Per-vessel CAD severity,segment involvement score and,segment stenosis score had significant effect on surgery planning. Conclusion: For elderly patients with suspected CHD and scheduled to have non-cardiac surgery at intermediate or high risk degree,the results of computed tomographic angiography would influence surgery planning obviously.