Pathogenesis and treatment for anesthesia-related coronary arterial spasm

麻醉相关冠状动脉痉挛的发病机制及治疗

• 批准号: 09470329
• 负责人: HOKA Sumio
• 金额: $ 6.72万
• 依托单位: KITASATO UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1997
• 资助国家: 日本
• 起止时间: 1997 至 1999
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09470329/
• 关键词: coronany spasm; perioperative; anesthesia; epidural block; vasopressors; risk factor; nitroglycerin; 手術; 交感神経; プロポフォール; 麻酔薬

The incidence of coronary arterial spasm is considered to be relatively high among Japanese compared to Caucasians (1), although the morbidity and mortality of coronary arterial disease are much lower in Japanese (2). A number of case reports of perioperative coronary artery spasm have been published in non-indexed Japanese anesthetic journals, and were to a large extent authored by Japanese. The individual reports show relatively small numbers of patients with specific conditions and treatment regimens, making it difficult to clearly define which factors affect perioperative coronary artery spasm. The purpose of this study is to investigate the contributing factors affecting perioperative coronary artery spasm by reviewing the published articles. Methods : Reports of the perioperative coronary artery spasm were identified by searching the Medline (1968-1998), and Japanese journals (1980-1998). The selected criteria for perioperative coronary artery spasm included ischemic electrocardi … More ographic changes as demonstrated typically by ST segment elevation without preceding remarkable changes in determinants of myocardial demand or supply, and the incidence occurred after arrival in the operating room before, during or following general and/or regional anesthesia. Results : The clinical characteristics of perioperative coronary spasm were analyzed in 115 patients. Mean age of patients was 64 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%). Drugs other than vasopressors as possible causes included prostaglandin E1, vecuronuim, doxapram, and trimethaphan. About 85% of patients showed no ischemic abnormality on the preoperative electrocardiogram, while 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, while defibrillation and cardiac massage were required in 19% of patients. No death was reported. Conclusion : The reported perioperative coronary spasm occurred mostly in elderly men who had certain preoperative risk factors, such as hypertension, angina pectoris, cigarette smoking and diabetes mellitus. Our findings suggest that the major factors that trigger perioperative coronary spasm include inadequate depth of general anesthesia, the use of vasopressors, vagus nerve stimulation, and drugs other than vasopressors. Perioperative coronary spasm is prevalent in patients undergoing abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity has received considerable attention as the underlying pathogenic mechanisms of coronary spasm. In summary, 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.In a porcine model of coronary artery spasm, the effects of epidural block or inhalational anesthesia on the incidence of serotonin-induced coronary hyperconstriction did not appeared, suggesting the minor contribution of anesthesia to coronary vasospasm in this porcine model. Less

与白种人相比，日本人冠状动脉痉挛的发生率被认为相对较高 (1)，尽管日本人冠状动脉疾病的发病率和死亡率要低得多 (2)。许多围手术期冠状动脉痉挛的病例报告已发表在日本非索引麻醉期刊上，并且大部分由日本人撰写。个别报告显示，具有特定病情和治疗方案的患者数量相对较少，因此很难明确确定哪些因素影响围手术期冠状动脉痉挛。本研究的目的是通过回顾已发表的文章来调查影响围术期冠状动脉痉挛的影响因素。方法：通过检索Medline（1968-1998）和日本期刊（1980-1998）来识别围手术期冠状动脉痉挛的报告。围手术期冠状动脉痉挛的选定标准包括缺血性心电图变化，通常通过 ST 段抬高来证明，而心肌需求或供应的决定因素没有事先发生显着变化，并且发生在全身和/或区域麻醉之前、期间或之后到达手术室之后。结果：对115例患者围手术期冠状动脉痉挛的临床特征进行分析。患者的平均年龄为 64 岁（范围为 36 至 87 岁）。其中男性 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。除血管加压药外，可能的原因包括前列腺素 E1、维库洛姆、多沙普仑和三甲芬。约85%的患者术前心电图未见缺血异常，而56%的患者术后冠状动脉造影显示明显的冠状动脉狭窄。吸入麻醉联合硬膜外阻滞的患者易发生冠状动脉痉挛。硝酸盐可以缓解大多数病例的发作，而 19% 的患者需要除颤和心脏按摩。没有死亡报告。结论：报道的围手术期冠状动脉痉挛多发生于老年男性，且术前有高血压、心绞痛、吸烟、糖尿病等危险因素。我们的研究结果表明，引发围手术期冠状动脉痉挛的主要因素包括全身麻醉深度不足、使用血管加压药、迷走神经刺激以及血管加压药以外的药物。在吸入麻醉联合硬膜外麻醉下接受腹部或胸部手术的患者中，围手术期冠状动脉痉挛很常见。自主神经系统的不稳定和/或血管高反应性作为冠状动脉痉挛的潜在致病机制受到了相当多的关注。总之，有冠状动脉危险因素的老年男性患者在吸入麻醉联合硬膜外麻醉下接受腹部或胸部手术时，围术期冠状动脉痉挛很常见。自主神经系统不稳定和/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。在猪冠状动脉痉挛模型中，硬膜外阻滞或吸入麻醉对血清素诱导的冠状动脉过度收缩发生率的影响并未出现，表明麻醉对冠状动脉痉挛的影响较小。 这个猪模型。较少的

项目成果

Hoka S: "Ventricular pressure-volume relation and anesthesia."Journal of Clinical Anesthesia (Japan). 23. 637-643 (1999)

Hoka S：“心室压力-容积关系与麻醉。”临床麻醉杂志（日本）。

外 須美夫: "ドパミンとドブタミンの周術期循環管理における使い分け"循環制御. 19. 160-164 (1998)

Sumio Soto：“围手术期循环管理中使用的德巴胺和多巴酚丁胺”循环控制。19. 160-164 (1998)。