Рerioperative高危冠心病患者的发病期

O. Gogayeva
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摘要

目的分析高危冠心病患者的围手术期。材料和方法。2009 - 2019年专科门诊手术出院194例,年龄64.2±8.9岁。所有患者均接受了实验室检查、心电图、超声心动图、冠状动脉造影和冠状动脉旁路移植术(CABG)。结果。所有患者均有血流动力学上明显的冠状动脉狭窄,需要冠脉搭桥。入院时诊断为急性心肌梗死12例(6.1%),不稳定型心绞痛72例(37.1%)。在合并症中,诊断为2型糖尿病的患者有50例(25.7%),糖耐量受损的患者有82例(42.2%),肥胖的患者有74例(38.1%),体重指数25-29.9 kg/m2的超重患者有86例(44.3%),诊断为慢性肾脏疾病的患者有75例(38.6%)。冠状动脉造影显示,平均狭窄冠状动脉数为3.5条。EuroSCORE II量表评估的风险为7.78%(5.01% ~ 68.25%)。工作心脏行心肌血运重建术187例(96.3%),非泵送7例(3.6%)。术后40例(20.6%)患者发生阵发性心房颤动。2例(1.03%)患者出现急性肾损伤,肌酐升高50%。结论。尽管预测死亡率很高(EuroSCORE II评分为7.78%),但所有患者平均在8.4±3.5天出院。仔细的术前诊断,准备,风险分层,手术期限的确定,CABG方法的选择,考虑到人体测量数据,下肢静脉的状态,冠状动脉的解剖位置,它们的直径和损伤程度,个性化的药物治疗,可以在最小的并发症下取得良好的效果。关键词:冠状动脉疾病,高危患者,冠状动脉搭桥术,合并症,非体外循环
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Рerioperative period of high-risk patients with coronary artery disease
The aim – to analyze the perioperative period of high-risk patients with coronary artery disease. Materials and methods. 194 patients (age 64.2 ± 8.9 years) with surgery performed, discharged from the specialized clinic within period from 2009 to 2019. All patients underwent laboratory tests, ECG, echocardiography, coronary angiography and coronary artery bypass grafting (CABG). Results. All patients had hemodynamically significant coronary artery stenosis, which required CABG. Acute myocardial infarction at the time of admission was diagnosed in 12 (6.1 %) patients, unstable angina – in 72 (37.1 %) patients. Among comorbid conditions, type 2 diabetes mellitus was diagnosed in 50 (25.7 %) patients, impaired glucose tolerance – in 82 (42.2 %) patients, obesity – in 74 (38.1 %) patients, 86 (44.3 %) patients were overweight with a body mass index 25–29.9 kg/m2, and 75 (38.6 %) patients were diagnosed with chronic kidney disease. According to coronary angiography, the average number of stenosed coronary arteries was 3.5. The risk assessed by EuroSCORE II scale was 7.78 % (from 5.01 % to 68.25 %). Myocardial revascularization was performed on the working heart in 187 (96.3 %) patients, on-pump in 7 (3.6 %) cases. In the postoperative period, 40 (20.6 %) patients developed paroxysmal atrial fibrillations. Acute kidney injury with increase in creatinine by 50 % occurred in 2 (1.03 %) patients. Conclusions. Despite the high predicted mortality (7.78 % by the EuroSCORE II scale) all the patients were discharged on average in 8.4 ± 3.5 days. Careful preoperative diagnosis, preparation, risk stratification, determination of the term of surgery, choice of CABG method taking into account the anthropometric data, the state of the lower extremities veins, anatomical location of coronary arteries, their diameter and degree of damage, personalized drug therapy, allows to achieve good results with minimal complications. Key words: coronary artery disease, high-risk patients, coronary artery bypass grafting, comorbid conditions, off-pump.
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