心臓外科手術を受けた患者の腕の梯度
Yvon Baribeau1, Benjamin M Westbrook, David C Charlesworth
1Department of Cardiac Surgery, Catholic Medical Center and New England Heart Institute, Manchester, NH 03102, USA. baribeau@nhheart.com
Circulation
|October 2, 2002
まとめ
心臓外科手術前の腕の血圧の差は,大動脈と大動脈の疾患のリスクが高まっていることを示します. これらのリスクを特定するために,手術前のイメージングが推奨されます.
科学分野:
- 心血管外科手術についてです.
- 血管医学 血管医学とは
- 診断用イメージング
背景:
- 腕間の血圧差の術前評価は,心臓外科手術の患者にとって極めて重要です.
- 腕血圧のグラデーションの臨床的影響を理解することで,外科計画とリスクの階層化に情報を提供することができます.
研究 の 目的:
- 術前手腕血圧の梯度と,頸動脈および近親大動脈動脈硬化症の存在との関連を調査する.
- ブラキアル血圧の梯度が心臓手術を受ける患者の脳血管疾患または死亡率の予測要因であるかどうかを判断する.
主な方法:
- 予見性研究で,腕血圧グラディエンント (グループ1) を有する53人の患者と,そうでない175人の患者 (グループ2) を比較した.
- すべての患者は,手術前の動脈二重尋問と手術中の動脈スキャンを受けた.
- 危険因子,頸動脈狭窄,大動脈疾患の重症度がグループごとに比較されました.
主要な成果:
- ブラキアル・グラデント (グループ1) の患者は,周周周血管疾患 (P<0.0001) と脳血管症状 (P=0.0196) の割合が著しく高かった.
- 重度の頸動脈狭窄症 (>80%) は,第1グループ (41.5%) と第2グループ (13.7%) (P<0.0001) の間でより一般的であった.
- 重度の近道大動脈疾患は,第1グループ (39.6%) と第2グループ (10.8%) (P<0.0001) でより一般的であった.
結論:
- 術前の腕圧のグラディエントは,大動脈の増加と近接性動脈硬化性大動脈疾患の重要なマーカーとして機能します.
- 術前頸動脈ドップラー検査と術後腹動脈超音波検査は,腕の梯度を持つ患者に強く推奨されます.
- 総合的なリスク評価のために, катетеризация中の術前アーチ研究の検討が推奨されます.
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