Clinical characteristics of perioperative coronary spasm: reviews of 115 case reports in Japan.
Clinical characteristics of perioperative coronary spasm: reviews of 115 case reports in Japan.
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DOI：
10.1007/s005400170034
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发表时间：
2001-01-01
影响因子：
2.8
通讯作者：
Hoka, S
中科院分区：
文献类型：
--
作者：
Koshiba, K;Hoka, S
目的：影响围手术期冠状动脉痉挛发生的因素尚未阐明。许多描述围手术期冠状动脉痉挛的病例报告出现在日本麻醉期刊上，大多数以日语发表。本研究的目的是探讨影响围手术期冠状动脉痉挛的因素，通过回顾已发表的article.METHODS：报告确定使用Medline数据库（1968-1998年）或手动检索nonindexed日本期刊。对115例在围手术期发生冠状动脉痉挛的患者进行围手术期冠状动脉痉挛的临床特征分析。结果：患者的平均年龄为64 ± 9岁（范围36 ~ 87岁）。男性97人（84%），女性18人（16%）。术前危险因素包括高血压（27%）、心绞痛（27%）、吸烟（13%）和糖尿病（11%）。发作与全身麻醉深度不足（23%）、使用血管加压药（22%）、迷走神经反射（19%）、使用血管加压药以外的药物（17%）和硬膜外阻滞（15%）有关。约85%的患者术前心电图显示无缺血性异常，而56%的患者术后冠状动脉造影显示有明显的冠状动脉狭窄。吸入麻醉联合硬膜外阻滞更易发生冠状动脉痉挛。硝酸盐缓解了大多数病例的发作，而19%的患者需要除颤和心脏按摩。无死亡报告。结论：在吸入麻醉联合硬膜外麻醉下接受腹部或胸部手术的有冠状动脉危险因素的老年男性患者中，围手术期冠状动脉痉挛普遍存在。自主神经系统的不稳定和/或血管高反应性可能是围手术期冠状动脉痉挛的潜在致病机制。
PURPOSE: Factors affecting perioperative development of coronary spasm have not been elucidated. A number of case reports describing perioperative coronary spasm have appeared in Japanese anesthesia journals, mostly published in Japanese. The purpose of this study was to investigate the contributing factors affecting perioperative coronary artery spasm by reviewing the published articles.METHODS: Reports were identified by using Medline database (1968-1998) or by manually searching nonindexed Japanese journals. The clinical characteristics of perioperative coronary spasm were analyzed in 115 patients who developed coronary artery spasm during the perioperative period.RESULTS: The mean age of the patients was 64 +/- 9 years (range, 36 to 87 years). There were 97 men (84%) and 18 women (16%). Preoperative risk factors included hypertension (27%), angina pectoris (27%), cigarette smoking (13%), and diabetes mellitus (11%). The attack was related to inadequate depth of general anesthesia (23%), use of vasopressors (22%), vagal reflex (19%), administration of drugs other than vasopressors (17%), and epidural block (15%). About 85% of patients showed no ischemic abnormality on the preoperative electrocardiogram, whereas 56% had significant coronary stenosis on postoperative coronary arteriography. Coronary spasm tended to occur in patients under inhalation anesthesia combined with epidural block. Nitrates alleviated the episode in the majority of cases, whereas defibrillation and cardiac massage were required in 19% of patients. No deaths were reported.CONCLUSION: Perioperative coronary spasm is prevalent in elderly male patients with coronary risk factors who undergo abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity may be the underlying pathogenic mechanisms of perioperative coronary spasm.