[Intraoperative coronary spasm in non-cardiac surgery].
[Intraoperative coronary spasm in non-cardiac surgery].
复制标题
非心脏手术中的术中冠状动脉痉挛[J].
DOI：
--
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
K. Hanaoka
中科院分区：
文献类型：
--
作者：
Kyung;K. Hanaoka
背景
心血管事件是围手术期最严重的并发症之一。本研究的目的是通过回顾已发表的文献，探讨术中冠状动脉痉挛的临床特征、有效治疗方法和临床结局。
方法
使用Medline数据库（1977-2000）或手动检索麻醉杂志（1987-2000）确定术中冠状动脉痉挛的报告。分析56例非心脏手术中发生冠状动脉痉挛的患者术中冠状动脉痉挛的临床特点。
结果
患者的平均年龄为58 ± 13岁。大多数患者为男性（75%）、日本人（78%），无胸痛病史（75%）。区域麻醉、血管加压药、痉挛、低血压、麻醉深度不足和迷走神经刺激是主要的影响因素。超过一半的患者表现出严重的低血压，30%的患者出现心血管性虚脱。然而，冠状动脉扩张剂，特别是硝酸盐，对治疗非常有效，临床结局相对较好（1例死亡和3例心肌梗死）。
结论
无胸痛病史的患者术中可能发生冠状动脉痉挛。一些术中情况本身就是强有力的血管收缩因素。一旦发生冠状动脉痉挛，建议立即给予全剂量的冠状动脉扩张剂。
BACKGROUND
Cardiovascular events are one of the most critical perioperative complications. The purpose of this study is to investigate the clinical characteristics, effective treatments, and clinical outcome of intraoperative coronary spasm through a review of the published literature.
METHODS
Reports of intraoperative coronary spasm were identified using the Medline database (1977-2000) or by manually searching the Journal of Anesthesia (1987-2000). The clinical characteristics of intraoperative coronary spasm were analyzed in the 56 patients who had developed coronary spasm during non-cardiac surgery.
RESULTS
The mean patient's age was 58 +/- 13 years. The majority of patients were men (75%), Japanese (78%), and had no history of chest pain (75%). Regional anesthesia, vasopressors, alkalosis, hypotension, inadequate depth of anesthesia, and vagal stimulation were noted as major contributing factors. More than half of the patients showed severe hypotension and 30% developed cardiovascular collapse. However, coronary dilators, and nitrates in particular, were very effective for the treatment, and the clinical outcome was relatively good (one death and three cases of myocardial infarction).
CONCLUSIONS
Intraoperative coronary spasm may develop in patients with no history of chest pain. Some of the intraoperative conditions themselves are potent vasoconstricting factors. Once coronary spasm occurs, immediate administration of a full dose of coronary dilators is recommended.