双源CT冠状动脉血管成像用于老年患者非心脏手术术前评估的价值

目的 评价双源CT冠状动脉血管成像(CTA)技术用于老年患者非心脏手术术前评估的价值。方法 回顾性分析本院2011年5月至2013年5月行冠状动脉CTA患者的临床资料,共有111例老年患者合并冠心病危险因素而既往未明确诊断冠心病,在非心脏手术术前评估时行CTA检查。冠状动脉CTA均采用双源CT前瞻性心电触发序列扫描。分析111例患者的CTA图像质量、狭窄程度、术前处理与围手术期并发症。结果 111例患者的1 779段冠状动脉可评价血管节段为1 676段(97.4%),患者的CTA有效放射剂量为(2.7±0.9) mSv。71例患者冠状动脉狭窄程度<50%,按期进行手术治疗,围手术期无心血管并发症发生；36例患者冠状动脉狭窄程度≥50%,其中狭窄程度≥70%的17例患者进行动脉造影检查：冠状动脉CTA诊断冠状动脉≥50%狭窄的敏感性为95%、特异性为96%；诊断冠状动脉≥70%狭窄的敏感性为97%、特异性为98%。这17例患者行冠状动脉支架或搭桥手术治疗。其余19例患者冠状动脉狭窄在50%~70%,积极内科保守治疗后行预定手术,术后2例患者出现心肌酶的一过性升高,无其他心血管并发症发生。结论 对于老年患者,术前行冠状动脉CTA检查能有效评估动脉狭窄程度,用于术前危险分层,指导进一步治疗,减少围手术期心血管并发症的发生。

Value of Dual-source Computed Tomography Angiography of Coronary Artery for Preoperative Evaluation of Old Patients Scheduled for Noncardiac Surgery

Objective To assess the role of computed tomography angiography (CTA) using dual-source computed tomography in the preoperative evaluation of old patients scheduled for noncardiac surgery. Methods A retrospective review of the clinical data of patients who underwent CTA in our hospital between May 2011 and May 2013 was performed,and totally 111 old patients with risk factors of coronary artery diseases scheduled for noncardiac surgery were found to coronary CTA for preoperative evaluation. Prospectively electrocardiograph-triggered sequence scan protocol with dual-source computed tomography was performed. The imaging quality,coronary artery stenosis,the treatment before operation,and perioperative complications were assessed. Results For 1 779 coronary artery segments in 111 patients,the number of evaluable segments was 1 676 (97.4%). The mean effective dose of CTA was (2.7±0.9) mSv. Among them,71 patients with coronary artery stenosis <50% underwent surgery without cardiac complication and 17 patients with coronary artery stenosis ≥70% underwent conventional coronary angiography and coronary angioplasty or bypass surgery. The sensitivity and specificity of CTA in detecting ≥50% stenosis were 95% and 96%,and the sensitivity and specificity of CTA in detecting ≥70% stenosis were 97% and 98%. For 19 patients with coronary artery stenosis between 50% and 70%,the levels of myocardial enzyme were transiently higher for two patients,and no other cardiac complication occurred. Conclusion Coronary artery CTA is reliable in artery stenosis evaluation and can be used as cardiac risk stratification for old patients scheduled for noncardiac surgery.