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[目的]探讨胸科恶性肿瘤(包括食管癌和肺癌)合并冠心病患者术前行冠脉造影及临床干预与围手术期心脏事件的相关性,并探讨术前应用冠脉造影评估心脏情况及临床干预的意义。[方法 ]选择胸科肿瘤且合并冠心病患者(共213例,其中冠脉造影组50例,未行冠脉造影组163例),通过单因素和多因素分析围手术期心脏事件的发生率与是否行冠脉造影、年龄、糖尿病等不同因素的相关性,并将患者按年龄分层(﹤65岁组和≥65岁组),再次分析以上因素与心脏事件的相关性。[结果]全组213例患者共51例发生围手术期心脏事件,其中冠脉造影组共发生心脏事件5例,未行冠脉造影组共发生46例;<65岁组围手术期共发生心脏事件21例,≥65岁组共发生心脏事件30例;吸烟组共发生心脏事件44例,未吸烟组共发生7例;糖尿病组共发生心脏事件21例,无糖尿病组共发生30例,各组差异均具有统计学意义(P<0.05)。单因素、多因素分析显示是否行冠脉造影、年龄、是否患高血压病、是否患糖尿病、是否吸烟是行胸科肿瘤冠心病患者围手术期心脏事件发生的独立影响因素(P均<0.05),其中冠脉造影为保护因素,其余几项均为危险因素。分层分析显示,﹤65岁组患者:是否行冠脉造影为独立保护因素,而是否患有糖尿病为独立危险因素;≥65岁组患者:是否行冠脉造影为独立保护因素,是否吸烟、是否患有糖尿病为独立危险因素。[结论]胸科肿瘤合并冠心病,尤其是高龄、合并糖尿病、高血压病、有吸烟史的患者,术前行冠脉造影评估心脏情况可降低心脏事件的发生率,因此推荐胸科肿瘤合并冠心病患者术前应用冠脉造影评估心脏情况。
[Objective] To explore the correlation between preoperative coronary angiography and clinical intervention and perioperative cardiac events in patients with thoracic malignancies (including esophageal and lung cancer) with coronary heart disease and to evaluate preoperative coronary angiography Significance of clinical intervention. [Methods] Thoracic tumors and patients with coronary heart disease (213 in total, including 50 coronary angiography groups and 163 non-coronary angiography groups) were selected. The incidences of perioperative cardiac events were analyzed by univariate and multivariate analysis Correlations with different factors such as coronary angiography, age, diabetes and other factors were stratified by age (<65 years old and ≥65 years old group), and again analyzed the correlation between the above factors and cardiac events. [Results] Perioperative cardiac events occurred in 51 patients in 213 patients. Among them, 5 were coronary events in coronary angiography group and 46 in non-coronary angiography group. Perioperative complications occurred in patients <65 years old Thirty-one cardiac events occurred in 21 cases of cardiac events and ≥65 years of age. There were 44 cardiac events in smoking group and 7 in non-smoking group. There were 21 cardiac events in diabetic group, 30 in non-diabetic group, All the differences were statistically significant (P <0.05). Univariate and multivariate analysis showed that coronary angiography, age, hypertension, diabetes and smoking were the independent influencing factors of perioperative cardiac events in patients with thoracic cancer with coronary heart disease (all P <0.05 ), Including coronary angiography as a protective factor, the remaining several are risk factors. Hierarchical analysis showed that patients under 65 years of age had coronary angiography as an independent protective factor and whether they had diabetes as an independent risk factor. Patients ≥65 years of age had coronary angiography as an independent protective factor, smoking, Whether or not you have diabetes is an independent risk factor. [Conclusion] Preoperative coronary angiography can reduce the incidence of cardiac events in patients with thoracic tumors complicated with coronary heart disease, especially those with advanced age, diabetes mellitus, hypertension and smoking history. Therefore, it is recommended that patients with thoracic tumors be merged Preoperative coronary angiography coronary angiography assessment of cardiac conditions.