Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
Curr Opin Anaesthesiol. 2010 Feb;23(1):109-15. doi: 10.1097/ACO.0b013e3283340b1a.
In recent years, an increasing number of patients have received coronary stents as a treatment for coronary artery disease. It is expected that more such patients will present to the operating room. The purpose of this review is to highlight the key issues and provide possible management strategies for these patients.
Currently published studies suggest that patients with coronary stents, and in particular those with drug-eluting stents, are at an increased risk of perioperative cardiac morbidity and mortality due to stent thrombosis. Total and premature discontinuation of dual antiplatelet therapy (aspirin and clopidogrel) is considered as the main culprit.
Caring for patients with coronary stents in the perioperative period requires input from a team consisting of anesthesiologists, surgeons and cardiologists. The management of the dual antiplatelet therapy regimen should be customized to each patient depending on the type and urgency of surgery, type of coronary stent, time since the coronary intervention and complexity of the coronary intervention. For patients identified at high risk for stent thrombosis, surgery should be planned in a hospital with cardiac catheterization facilities. Postoperatively, these patients require a monitored setting and their antiplatelet agents restarted immediately. Signs and symptoms of stent thrombosis should be promptly recognized and aggressively treated with percutaneous coronary intervention.
近年来，越来越多的冠心病患者接受冠状动脉支架治疗。预计将有更多此类患者进入手术室。本文旨在强调这些患者的关键问题并提供可能的处理策略。
目前已发表的研究表明，由于支架内血栓形成，接受冠状动脉支架治疗的患者（尤其是药物洗脱支架）围手术期发生心脏并发症和死亡的风险增加。双重抗血小板治疗（阿司匹林和氯吡格雷）的完全和过早停药被认为是主要原因。
围手术期需要由麻醉师、外科医生和心脏病专家组成的团队共同照顾接受冠状动脉支架治疗的患者。应根据手术类型和紧急程度、冠状动脉支架类型、冠状动脉介入治疗时间和介入治疗的复杂性，为每位患者定制双重抗血小板治疗方案。对于支架内血栓形成高风险的患者，应计划在具有心脏导管插入术设施的医院进行手术。术后，这些患者需要在监护环境中，并立即重新开始使用抗血小板药物。应及时识别支架内血栓形成的迹象和症状，并通过经皮冠状动脉介入治疗积极治疗。
