Chang Kyung-ho, Hanaoka Kazuo
Department of Anesthesiology, Faculty of Medicine, University of Tokyo, Tokyo 113-8655.
Masui. 2004 Jan;53(1):2-9.
Cardiovascular events are one of the most critical perioperative complications. The purpose of this study is to investigate the clinical characteristics, effective treatments, and clinical outcome of intraoperative coronary spasm through a review of the published literature.
Reports of intraoperative coronary spasm were identified using the Medline database (1977-2000) or by manually searching the Journal of Anesthesia (1987-2000). The clinical characteristics of intraoperative coronary spasm were analyzed in the 56 patients who had developed coronary spasm during non-cardiac surgery.
The mean patient's age was 58 +/- 13 years. The majority of patients were men (75%), Japanese (78%), and had no history of chest pain (75%). Regional anesthesia, vasopressors, alkalosis, hypotension, inadequate depth of anesthesia, and vagal stimulation were noted as major contributing factors. More than half of the patients showed severe hypotension and 30% developed cardiovascular collapse. However, coronary dilators, and nitrates in particular, were very effective for the treatment, and the clinical outcome was relatively good (one death and three cases of myocardial infarction).
Intraoperative coronary spasm may develop in patients with no history of chest pain. Some of the intraoperative conditions themselves are potent vasoconstricting factors. Once coronary spasm occurs, immediate administration of a full dose of coronary dilators is recommended.
心血管事件是围手术期最严重的并发症之一。本研究旨在通过回顾已发表的文献，探讨术中冠状动脉痉挛的临床特征、有效治疗方法及临床结局。
利用Medline数据库（1977 - 2000年）或通过手工检索《麻醉学杂志》（1987 - 2000年）来确定术中冠状动脉痉挛的报告。对56例在非心脏手术期间发生冠状动脉痉挛的患者的临床特征进行了分析。
患者的平均年龄为58±13岁。大多数患者为男性（75%）、日本人（78%），且无胸痛病史（75%）。区域麻醉、血管升压药、碱中毒、低血压、麻醉深度不足及迷走神经刺激被认为是主要促成因素。超过半数的患者出现严重低血压，30%发生心血管虚脱。然而，冠状动脉扩张剂，尤其是硝酸盐类药物，治疗效果非常显著，临床结局相对较好（1例死亡，3例心肌梗死）。
无胸痛病史的患者术中可能发生冠状动脉痉挛。一些术中情况本身就是强大的血管收缩因素。一旦发生冠状动脉痉挛，建议立即给予足量的冠状动脉扩张剂。
