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目的探讨胃肠道肿瘤病人合并冠心病的围手术期处理方法。方法回顾性分析2007年7月至2008年8月昆明医学院临床肿瘤学院诊治52例胃肠道肿瘤并存冠心病病人的临床资料。术前评估和处理参照2007年美国心脏病学会美国心脏病学院(ACC/AHA)指南。结果冠脉造影支架置入5例,气囊扩张15例,β1受体阻断剂等药物综合治疗32例。病人术后30d内发生心脏相关的并发症8例(15.4%),其中急性心衰1例(1.9%),心肌梗死死亡2例(3.8%),心绞痛复发3例(5.8%),难治性心律失常2例(3.8%)。结论合并冠心病的胃肠道肿瘤病人在围手术期间风险较高,参照ACC指南,采用多学科协作的术前评估和处理有助于降低心脏并发症的发生率。
Objective To investigate the perioperative management of patients with gastrointestinal cancer complicated with coronary heart disease. Methods The clinical data of 52 patients with gastrointestinal cancer complicated with coronary heart disease (CHD) diagnosed and treated by Clinical Oncology School of Kunming Medical College from July 2007 to August 2008 were retrospectively analyzed. Refer to the 2007 American College of Cardiology American College of Cardiology guidelines for preoperative evaluation and management. Results Coronary angiography stent implantation in 5 cases, balloon dilation in 15 cases, β1 receptor blockers and other drugs in 32 cases. Eight patients (15.4%) had heart-related complications within 30 days after operation, including 1 case of acute heart failure (1.9%), 2 cases of myocardial infarction death (3.8%) and 3 cases of recurrence of angina (5.8% 2 cases of arrhythmia (3.8%). Conclusions Patients with gastrointestinal cancer with coronary heart disease are at a higher risk during perioperative period. According to ACC guidelines, preoperative evaluation and treatment with multidisciplinary collaboration may help to reduce the incidence of cardiac complications.