运动平板实验Duke评分对冠心病患者非心脏手术术前评估的价值  

Preoperative assessment value of treadmill experimental Duke score of coronary artery disease in patients with non-cardiac surgery

作　　者：张俊芳[1] 

机构地区：[1]河北省邯郸市第一医院心内二科,056002

出　　处：《中国综合临床》2013年第5期495-498,共4页Clinical Medicine of China

摘　　要：目的分析运动平板试验Duke评分（DTS）对冠心病患者非心脏手术围术期心脏事件的评价功能。方法2010年5月至2011年5月连续收住我院的45—75岁大中型非心脏手术冠心病患者184例，术前进行心脏彩超、运动平板实验检查，术前检查内科主要疾病史及体格检查，按Duke评分分为DTS低危组（5≤Duke评分≤15，124例）、DTS中危组（-10≤Duke评分〈5分，60例），该实验排除DTS高危组的患者。对比分析手术类型、内科主要疾病史、术中术后主要心血管并发症等。结果两组手术类型和麻醉方式及心血管疾病史差异均无统计学意义（P均〉0．05）；DTS低危组年龄（59．2±4．1）岁，术前心功能不全2例（1．6％）、左心室射血分数〈0．50者2例（1．6％），糖尿病史12例（9．6％），有心绞痛症状者51例（41．1％），心电图有缺血改变者55例（44．3％）；DTS中危组年龄（65．2±2．6）岁，术前心功能不全8例（13．3％），左心室射血分数〈0．50为5例（8．3％），糖尿病史23例（38．3％），有心绞痛症状者60例（100％），心电图有缺血改变者40例（66．7％），两组比较差异均有统计学意义[t=2．98，P=0．042；χ2值分别为4．93、3．84、4．67、5．24、3．58，P均〈0．05]。DTS低危组患者术中心律失常、高血压发生率分别为6．5％（8／124）及22．5％（28／124），DTS中危组患者术中心律失常、高血压发生率分别为11．6％（7／60）及18．3％（11／60），与DTS低危组相比，DTS中危组术中心律失常和高血压的比数比（OR）及95％可信区间分别是1．7（0．8～3．3），0．8（0．4—1．4），P值分别为0．062、0．074，差异均无统计学意义。控制年龄和性别后DTS低危组术后心肌梗死、心源性肺水肿发生率分别为0．8％（1／124）及2．4％（3／124），DTS中危组术后心肌梗死、心源性肺水肿发生率分别为10．Objective To analysis of treadmill exercise test Duke score（DTS） in patients with coronary heart disease than the evaluation functions of heart operation perioperative cardiac events. Methods One hundred and eighty-four patients with coronary heart disease, 45 - 75 years of medium-sized non cardiac operation,were chose from May, 2010 to May, 2011 in our hospital, Cardiac ultrasound, treadmill exercise test were taken before operation, preoperative examination department of internal medicine disease history and physical examinations. According to the Duke score, they were divided into DTS in low risk group （5 ≤ Duke ≤ 15, n = 124 ）, medium risk group DTS （ DTS ： （ - 10 ≤ Duke ≤ 5, n = 60）, the exclusions of patients with high-risk DTS group, and the high-risk group of patients were excluded. Comparative analysis of operations, the main type of Department of internal medicine disease history, intraoperative and postoperative major cardiovascular complications. Results In the two groups of operation type and the type of anesthesia and cardiovascular disease,there is no significant difference （P 〉 0.05 ）;in DTS low risk group the age （59.2 ± 4. 1 ）years, preoperative cardiac dysfunction were 2 cases, left ventricular ejection fraction 〈 0. 50 were 2 case （ 1.6% ）, diabetes history 12 case （9. 6% ）, with angina pectoris symptoms of 51 case（41.1% ）, ECG ischemic changes in 55 （44. 3 % ）, in the medium DTS risk group, the age （65.2 ± 2. 6）years, preoperative cardiac dysfunction were 8 cases（ 13.3% ）, left ventricular ejection fraction of 〈 0. 50 was 5 case （ 8.3% ）, diabetes history 23 case （38.3%） ,angina pectoris and 60 case （100%）, ECG ischemic changes in 40 case （66. 7% ）（t = 2. 98, P = 0. 042, χ2 values were 4. 93,3.84,4. 67,5.24,3.58, P 〈 0.05 ）. The low risk group of patients with arrhythmia, hypertension incidence rate were 6. 5% （8/124） and 22. 5% （28/124）, medium risk group of patients with arrhythmia,hypertension in

关 键 词：运动平板试验 DUKE评分 冠心病患者非心脏手术 

分 类 号：R541.4[医药卫生—心血管疾病]