Baribeau Yvon, Westbrook Benjamin M, Charlesworth David C, Hearne Michael J, Bradley William A, Maloney Christopher T
Department of Cardiac Surgery, Catholic Medical Center and New England Heart Institute, Manchester, NH 03102, USA.
Circulation. 2002 Sep 24;106(12 Suppl 1):I11-3.
Review of the clinical and therapeutic implications of difference in arm blood pressure detected preoperatively in patients having heart surgery.
Prospective study of 53 patients (Group 1) with gradient and comparison with a group of 175 patients without gradient (Group 2). All patients had preoperative carotid duplex interrogation and operative epiaortic scanning. There was no statistical difference regarding age, sex, status, redo, diabetes, ejection fraction, prior myocardial infarct, hyperlipidemia, or creatinine level. Risks factors for Group 1 included peripheral vascular disease (P<0.0001) and cerebrovascular symptoms (P=0.0196). Severe carotid disease (>80% stenosis) was seen in 41.5% of Group 1 and 13.7% of Group 2 (P<0.0001) patients. Severe atherosclerotic proximal aortic disease was found in 39.6% of Group 1 and 10.8% of Group 2 (P<0.0001) patients. There were 7 patients with strokes in Group 1 (13.20%) and 9 in Group 2 (5.14%; P=0.06). Four patients died in Group 1 (7.54%) and 10 died in Group 2 (5.71%; P=0.74).
Brachial gradient is a marker for increased carotid and proximal atherosclerotic aortic disease. Preoperative arch study at the time of catheterization is strongly recommended, as well as preoperative carotid Doppler and operative epiaortic ultrasound.
回顾心脏手术患者术前检测到的双臂血压差异的临床及治疗意义。
对53例有压差的患者（第1组）进行前瞻性研究，并与175例无压差的患者（第2组）进行比较。所有患者术前行颈动脉双功超声检查及术中主动脉表面超声检查。两组在年龄、性别、病情、再次手术、糖尿病、射血分数、既往心肌梗死、高脂血症或肌酐水平方面无统计学差异。第1组的危险因素包括外周血管疾病（P<0.0001）和脑血管症状（P=0.0196）。第1组41.5%的患者和第2组13.7%的患者出现严重颈动脉疾病（狭窄>80%）（P<0.0001）。第1组39.6%的患者和第2组10.8%的患者发现严重的近端主动脉粥样硬化疾病（P<0.0001）。第1组有7例患者发生卒中（13.20%），第2组有9例（5.14%；P=0.06）。第1组4例患者死亡（7.54%），第2组10例患者死亡（5.71%；P=0.74）。
肱动脉压差是颈动脉及近端主动脉粥样硬化疾病增加的一个标志。强烈建议在导管插入术时进行术前主动脉弓检查，以及术前颈动脉多普勒检查和术中主动脉表面超声检查。
