| 马景涛,刘 敬,郭丽敏.术前冠脉造影及其临床干预在降低胸科恶性肿瘤并冠心病患者围手术期心脏事件的临床研究[J].中国肿瘤,2017,26(4):321-326. |
| 术前冠脉造影及其临床干预在降低胸科恶性肿瘤并冠心病患者围手术期心脏事件的临床研究 |
| Preoperative Coronary Angiography and Clinical Intervention Reduces Perioperative Cardiac Events in Thoracic Cancer Patients with Coronary Heart Disease |
| 投稿时间：2016-10-12 |
| DOI：10.11735/j.issn.1004-0242.2017.04.A015 |
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| 中文关键词: 冠脉造影 围手术期 危险因素 心脏事件 心脏评估 |
| 英文关键词:coronary angiography perioperative period risk factors heart attack cardiac assessment |
| 基金项目:河北科技支撑计划项目（13277777） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨胸科恶性肿瘤（包括食管癌和肺癌）合并冠心病患者术前行冠脉造影及临床干预与围手术期心脏事件的相关性，并探讨术前应用冠脉造影评估心脏情况及临床干预的意义。［方法］ 选择胸科肿瘤且合并冠心病患者（共213例，其中冠脉造影组50例，未行冠脉造影组163例），通过单因素和多因素分析围手术期心脏事件的发生率与是否行冠脉造影、年龄、糖尿病等不同因素的相关性，并将患者按年龄分层（﹤65岁组和≥65岁组），再次分析以上因素与心脏事件的相关性。［结果］ 全组213例患者共51例发生围手术期心脏事件，其中冠脉造影组共发生心脏事件5例，未行冠脉造影组共发生46例；<65岁组围手术期共发生心脏事件21例，≥65岁组共发生心脏事件30例；吸烟组共发生心脏事件44例，未吸烟组共发生7例；糖尿病组共发生心脏事件21例，无糖尿病组共发生30例，各组差异均具有统计学意义（P＜0.05）。单因素、多因素分析显示是否行冠脉造影、年龄、是否患高血压病、是否患糖尿病、是否吸烟是行胸科肿瘤冠心病患者围手术期心脏事件发生的独立影响因素（P均＜0.05），其中冠脉造影为保护因素，其余几项均为危险因素。分层分析显示，﹤65岁组患者：是否行冠脉造影为独立保护因素，而是否患有糖尿病为独立危险因素；≥65岁组患者：是否行冠脉造影为独立保护因素，是否吸烟、是否患有糖尿病为独立危险因素。［结论］ 胸科肿瘤合并冠心病，尤其是高龄、合并糖尿病、高血压病、有吸烟史的患者，术前行冠脉造影评估心脏情况可降低心脏事件的发生率，因此推荐胸科肿瘤合并冠心病患者术前应用冠脉造影评估心脏情况。 |
| 英文摘要: |
| Abstract：［Purpose］ To investigate the effect of preoperative coronary angiography and clinical intervention on perioperative cardiac events in thoracic cancer patients with coronary heart disease. ［Methods］ Two hundred and thirteen coronary heart disease patients with thoracic cancer (esophageal and lung cancer) who underwent thoracic surgery were enrolled in the study. Among 213 cases，coronary angiography was performed in 50 cases before operation. The correlation between incidence of perioperative cardiac events and preoperative coronary angiography，age，diabetes was analyzed by univariate and multivariate analysis；and also analyzed in <65 age group and ≥65 age group，respectively.［Results］ A total of 51 cases of perioperative cardiac events occurred among 213 patients，including 5 cases in coronary angiography group，and 46 cases in non-coronary angiography group. There were 21 cases in <65 age group，30 cases in≥65 age group；44 cases in smoking group，6 cases in non-smoking group；21 cases in diabetic group，30 cases in non-diabetic group(all P＜0.05). Univariate and multivariate analysis demonstrated that coronary angiography was protective factor，while age，hypertension，diabetes，smoking were independent risk factors of perioperative cardiac events in thoracic cancer patients with coronary heart disease. Stratified analysis illustrated that in <65 age group，coronary angiography and clinical intervention were also independent protective factors，while diabetes was an independent risk factor；in ≥65 age group，coronary angiography and clinical intervention were independent protective factors，and smoking and diabetes were independent risk factors. ［Conclusion］ Preoperative coronary angiography and clinical intervention can reduce the incidence of cardiac events in thoracic cancer patients with coronary heart disease，especially those with older age，diabetes，hypertension and smoking. |
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