對(duì)很多病人來(lái)說(shuō)，同一天進(jìn)行冠狀動(dòng)脈造影和手術(shù)可能是安全、更加方便并且成本較低的治療方案。

“我們研發(fā)了一種方案使得病人能安全接受冠脈造影的同一天接受所選擇的手術(shù)。” Mayo診所的心臟專家David Holmes Jr 博士說(shuō)。 

過(guò)去，在同一天進(jìn)行冠脈造影和手術(shù)最大的風(fēng)險(xiǎn)可能會(huì)導(dǎo)致腎臟衰竭，是一種心臟術(shù)后死亡的獨(dú)立前兆因子，死亡率據(jù)報(bào)道高達(dá)44.4%到63.7%。血管造影中使用的染料與放射對(duì)比試劑誘導(dǎo)的腎病相關(guān)。這種染料可導(dǎo)致腎臟衰竭。

當(dāng)腎臟功能惡化，血清肌酐水平會(huì)在24到72小時(shí)內(nèi)增高，3到5天內(nèi)會(huì)達(dá)到高峰并在之后的3到5天恢復(fù)正常，這也是血管造影和手術(shù)必須間隔一段時(shí)間的原因。Holmes解釋道。

Mayo的研究人員評(píng)價(jià)了236例醫(yī)學(xué)記錄，主要是關(guān)于在同一天同時(shí)進(jìn)行心臟導(dǎo)管和手術(shù)修復(fù)的案例。病人的平均年齡為65歲并且33%為女性。226個(gè)病例中，血管造影顯示28.3%的病例具有足夠嚴(yán)重的冠狀動(dòng)脈疾病并需接受旁路手術(shù)的指征。有一例病人在手術(shù)后的30天死亡，4例病人之后有暫時(shí)性腎臟衰竭。

為了在同一天中同時(shí)進(jìn)行血管造影和手術(shù)并且消除腎臟衰竭的可能性，臨床醫(yī)生使用了其它對(duì)比試劑。最小程度減低了對(duì)比試劑的用量并嚴(yán)密觀察腎臟疾病的發(fā)生危險(xiǎn)。根據(jù)病人的腎臟功能使用不同的造影試劑。Holmes說(shuō)，“除外，確定病人是否會(huì)在此治療方案中獲益，必須仔細(xì)評(píng)價(jià)病人情況并在造影師和外科大夫間建立起良好的合作關(guān)系?！?

Heart: Same-Day Angiography and Surgery Is Safe

It may be safe, much more convenient and less costly for many patients to undergo coronary angiography and elective valve surgery on the same day.

“We have developed a protocol to allow patients to safely have coronary angiography on the same day as their elective surgery,” says David Holmes Jr., M.D., a cardiologist at Mayo Clinic and one of the authors of the new study. 

One of the primary concerns of performing coronary angiography the same day as surgery is the risk of acute kidney failure, an independent predictor of death after cardiac surgery; mortality rates have been reported as high as 44.4 percent to 63.7 percent, the researchers report. The dye used in angiography is associated with radiocontrast-induced nephropathy, which can cause kidney failure. 

When worsening kidney function occurs, serum creatinine levels begin to increase after 24 to 72 hours, peak within three to five days and return to normal within another three to five days, thus the reason for the delay between the angiography and surgery, Holmes explains. 

Mayo researchers evaluated the medical records of 226 consecutive patients who had undergone cardiac catheterisation on the day of elective valve repair or replacement. The average age of the patient was 65 years old and 33 percent were female. Of the 226, angiography showed that 28.3 percent had severe enough coronary artery disease to also require bypass surgery, in addition to valve surgery. One patient died within 30 days following surgery, and four of the patients had transient renal failure. 

To make it possible to do angiography and surgery on the same day and largely diminish the possibility of renal failure, the physicians used other contrast agents. They minimized the total amount of contrast and carefully screened patients at risk for kidney disease. Different agents are used based on the patient’s kidney function, Holmes says. “In addition, deciding which patients may benefit from this streamlined approach is dependent on careful patient assessment and collaboration between the cardiologist and cardiovascular surgeon,” he says.