Newsome Lisa T, Weller Robert S, Gerancher J C, Kutcher Michael A, Royster Roger L
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
Anesth Analg. 2008 Aug;107(2):570-90. doi: 10.1213/ane.0b013e3181731e95.
The management of patients with coronary artery stents during the perioperative period is one of the most important patient safety issues clinicians confront. Perioperative stent thrombosis is a life-threatening complication for patients with either bare-metal or drug-eluting stents. Noncardiac surgery appears to increase the risk of stent thrombosis, myocardial infarction, and death, particularly when patients undergo surgery early after stent implantation. The incidence of complications is further increased when dual-antiplatelet therapy is discontinued preoperatively. It is generally agreed that aspirin must be continued throughout the perioperative period, except in circumstances when the risk of bleeding significantly outweighs the benefit of continued anticoagulation, such as procedures performed in a closed space. We present considerations for regional anesthesia, as well as postoperative recommendations as the occurrence of perioperative stent thrombosis appears to be greatest during this period. Immediate percutaneous coronary intervention is the definitive treatment for perioperative stent thrombosis, and 24-h access to an interventional cardiology suite should be readily available. Algorithms for perioperative management of patients with bare-metal and drug-eluting stents are proposed.
冠状动脉支架植入患者围手术期的管理是临床医生面临的最重要的患者安全问题之一。围手术期支架血栓形成对于裸金属支架或药物洗脱支架患者而言是一种危及生命的并发症。非心脏手术似乎会增加支架血栓形成、心肌梗死和死亡的风险，尤其是在患者支架植入后不久便接受手术时。术前停用双联抗血小板治疗会进一步增加并发症的发生率。人们普遍认为，在整个围手术期都必须继续使用阿司匹林，除非出血风险明显超过继续抗凝的益处，例如在封闭空间内进行的手术。我们提出了区域麻醉的注意事项以及术后建议，因为围手术期支架血栓形成似乎在此期间发生率最高。直接经皮冠状动脉介入治疗是围手术期支架血栓形成的确定性治疗方法，应随时能够在24小时内使用介入心脏病学套件。本文提出了裸金属支架和药物洗脱支架患者围手术期管理的算法。
