Τόμος 12 (1994) – Τεύχος 4 – Άρθρο 1 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 12 (1994) – Issue 4 – Article 1 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

Από | | Άρθρο - Article, Ευτύχιος Μ. Βορίδης,Eutychios M. Voridis, Κωνσταντίνος Δ. Μάλλιος - Constantinos D. Mallios, Πλήρες Κείμενο στα Ελληνικά - Full Text in Greek

 

Τίτλος – Title

Εξωκαρδιακές Εγ­χει­ρή­σεις σε Στεφανιαίους Ασθενείς

Non Cardiac Surgery in Patients with Coronary Artery Disease
Συγγραφέας – Author

Κωνσταντίνος  Δ. Μάλλιος και Ευτύχιος  Μ. Βορίδης

Καρδιολογική Κλινική Διαγνωστικού και Θεραπευτικού Κέντρου Αθηνών ΥΓΕΙΑ Λ. Κηφισίας και Ερ. Σταυρού 4, 151 23 Αμαρούσιο, Αθήνα, Ελλάδα

Constantine D. Mallios and Eutychios M. Voridis

Cardiology Department, Diagnostic and Thera­peutic Center Hygeia, Athens, Greece
Παραπομπή – Citation

Μάλλιος,Κ.Δ.,  Βορίδης,Ε.Μ. : Εξωκαρδιακές Εγ­χει­ρή­σεις σε Στεφανιαίους Ασθενείς , Επιθεώρηση Κλιν. Φαρμακολ. Φαρμακοκινητ. 12 : 151-166 (1994)

Mallios,C.D., Voridis,E.M. : Non Cardiac Surgery in Patients with Coronary Artery Disease , Epitheorese Klin. Farmakol. Farmakokinet. 12 : 151-166 (1994)
Ημερομηνία Δημοσιευσης – Publication Date
20-12-1994
Γλώσσα Πλήρους Κειμένου –
Full Text Language

Ελληνικά – Greek
Παραγγελία – Αγορά –
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Λέξεις κλειδιά – Keywords

Ε­ξω­καρ­δια­κή εγ­χεί­ρη­ση, στε­φα­νια­ί­α νό­σος, πε­ριεγ­χει­ρη­τι­κό έμ­φραγ­μα, δεί­κτες καρ­δια­κού κιν­δύ­νου

Νοn-cardiac surgery, coronary artery disease, perioperative myocardial in­farction, cardiac risk assessment
Λοιποί Όροι – Other Terms

Άρθρο

Article
Περίληψη – Summary

Οι στε­φα­νια­ί­οι α­σθε­νείς, οι ο­ποί­οι υ­πο­βάλ­λο­νται σε ε­ξω­καρ­δια­κή χει­ρουρ­γι­κή ε­πέμ­βα­ση έ­χουν θνη­σιμό­τη­τα, πε­ρί­που, τρι­πλά­σια σε σχέ­ση με το γε­νι­κό πλη­θυ­σμό. Ο καρ­δια­κός θά­να­τος εί­ναι η συ­χνό­τε­ρη αι­τί­α θα­νά­του κα­τά την πε­ριεγ­χει­ρη­τι­κή πε­ρί­ο­δο και εί­ναι α­πο­τέ­λε­σμα ι­σχαι­μι­κής, αι­μο­δυ­να­μι­κής ή αρ­ρυθ­μιο­λο­γι­κής δια­τα­ρα­χής. Οι ι­σχαι­μι­κές δια­τα­ρα­χές εί­ναι οι συ­χνό­τε­ρες, ε­νο­χο­ποι­ο­ύ­νται για την εμ­φά­νι­ση των άλ­λων ε­πι­πλο­κών και εκ­δη­λώ­νο­νται, κυ­ρί­ως, υ­πό τη μορ­φή του ο­ξέ­ος εμ­φράγ­μα­τος, η συ­χνό­τη­τα του ο­ποί­ου εί­ναι της τά­ξε­ως του 1,9%. Τα πε­ριεγ­χει­ρη­τι­κά εμφράγ­μα­τα εμ­φα­νί­ζο­νται ε­ντός της πρώ­της ε­βδο­μά­δος (75%), εί­ναι, συ­χνά, α­συ­μπτω­μα­τι­κά (60%), συ­νή­θως χω­ρίς ΗΚ­Γ/γι­κά ευ­ρή­μα­τα νε­κρώ­σε­ως (non Q εμ­φράγ­μα­τα) και έ­χουν βα­ρει­ά πρό­γνω­ση (θνη­σιμό­τη­τα 25-50%). Οι ερ­γώ­δεις εγ­χει­ρή­σεις, ι­δί­ως του θώ­ρα­κος και των με­γά­λων αγ­γεί­ων, οι με­γά­λης διαρ­κείας και οι ε­πεί­γου­σες ε­πη­ρε­ά­ζουν αρ­νη­τι­κά την ε­ξέ­λι­ξη της ε­πεμ­βά­σε­ως. Η γε­νι­κή κα­τά­στα­ση του α­σθε­νούς  και η φαρ­μα­κευ­τι­κή α­γω­γή, την ο­ποί­αν λαμ­βά­νει, πρέ­πει να ε­λέγ­χο­νται, ε­νώ η κλι­νι­κο­ερ­γα­στη­ρια­κή ει­κό­να κα­θο­ρί­ζει τη βα­ρύ­τητα της νό­σου και κατ΄ ε­πέ­κτα­ση την πε­ριεγ­χει­ρη­τι­κή έκ­βα­σή της. Η α­στα­θής στη­θάγ­χη και η στη­θάγ­χη κλά­σε­ως III και IV σύμ­φω­να με την Κα­να­δι­κή  τα­ξι­νό­μη­ση αυ­ξά­νουν τον κίν­δυ­νον ε­πι­πλο­κών. Το προ­ϋ­πάρ­χον έμ­φραγ­μα (ύ­παρ­ξη κύ­μα­τος Q στο ΗΚ­Γ/φη­μα η­ρε­μί­ας), ευ­νο­εί την εμ­φά­νι­ση του πε­ριεγ­χει­ρη­τι­κού εμ­φράγ­μα­τος, εξ ου και η εγ­χεί­ρη­ση, εφ΄ ό­σον εί­ναι δυ­να­τόν, πρέ­πει να α­πο­φεύ­γε­ται ε­ντός του ε­ξα­μή­νου α­πό την αρ­χι­κή μυο­καρ­δια­κή νέ­κρω­ση. Η πρώ­ιμα θε­τι­κή δο­κι­μα­σί­α κο­πώ­σε­ως, εφ΄ ό­σον πραγ­μα­το­ποι­η­θεί, προ­δι­κά­ζει βα­ρεί­α πε­ριεγχει­ρη­τι­κή ε­ξέ­λι­ξη, ε­νώ δια της η­χω­καρ­διο­γρα­φί­ας ε­λέγ­χο­νται οι πι­θα­νό­τη­τες εμ­φα­νί­σε­ως, κυ­ρί­ως, αι­μο­δυ­να­μι­κών ε­πι­πλο­κών. Οι ρα­δϊ­ο­σο­το­πι­κές τε­χνι­κές (δο­κι­μα­σί­ες φορ­τί­σε­ως), κα­θο­ρί­ζο­ντας την ε­ντό­πι­ση, την έ­κτα­ση της μυο­καρ­δια­κής βλά­βης και τη βιω­σι­μό­τη­τα του πλη­γέ­ντος μυο­καρ­δί­ου, πα­ρέ­χουν α­ξιό­πι­στες πλη­ρο­φο­ρί­ες για την πο­ρεί­α της ε­πεμ­βά­σε­ως. Η στε­φα­νιο­γρα­φί­α, τέ­λος, εί­ναι α­πα­ραί­τη­τη στις πε­ρι­πτώ­σεις στη­θάγ­χης, α­στα­θούς, κλά­σε­ως III και IV και με­τεμ­φραγ­μα­τι­κής δι΄ α­σφα­λή ε­κτί­μη­ση της βα­ρύ­τη­τας της νό­σου και προγραμ­μα­τι­σμόν των χει­ρουρ­γι­κών ε­πεμ­βά­σε­ων.

Patients with coronary artery disease who undergo non-cardiac surgery have three times higher mortality than the general population. The most common cause of mortality is cardiac death during the perioperative period and comes as a result of ischaimic, haemodynamic or ar­rhythmic abnormalities. Cardiac ischaemia is common, is responsible for other complications and presents mainly as acute myocardial infarc­tion, with an incidence rate of around 1,9%. Perio­perative myocardial infarction occurs during the first week (75%), is often symptomless (60%), usually without typical ECG changes (non-Q wave infarction) and has a poor prognosis (mortality 25-50%). Major surgery, especially intrathoracic and aortic, long duration and emergency operations increase the operative risk. The patient’s general state and medical treatment must be considered, while the clinical examination and the laboratory investigation results determine the severity of the disease and, therefore, the perioperative risk. Un­stable angina and angina class III or IV, according to the Canadian classification, increase the com­plication risk. Prior myocardial infarction (Q wave in the resting ECG) is a risk factor for further pe-rioperative infarction and, therefore, surgery should be postponed, if possible, for 6 months af­ter the initial event. An early positive exercise test, if performed, suggests a poor perioperative course. Echocardiography assesses, mainly, the risk for postoperative heamodynamic complica­tions. Radionuclide techniques (stress tests) de­termine the site and extent of myocardial is­chaemia, the viability of the injured myocardium and give a reliable assessment of the operative risk. Finally, coronary arteriography is mandatory in unstable angina, class III or IV angina and post myocardial infarction angina in order to accurately assess the coronary artery disease severity and plan the non-cardiac operation.
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