Lazor L, Russell J C, DaSilva J, Radford M
Department of Surgery, University of Connecticut Medical Center, Farmington.
Surg Gynecol Obstet. 1988 Sep;167(3):234-8.
A retrospective study was undertaken at three hospitals of 196 patients who underwent an operative procedure as long as 60 days after radionuclide determination (multiple uptake gated acquisition scan [MUGA]) of left ventricular ejection fraction (LVEF). Cardiac related mortality rates were 2.2 per cent among patients in group 1, LVEF greater than or equal to 55 per cent; 5.4 per cent in group 2, LVEF 36 to 54 per cent, and 19.5 per cent in group 3, LVEF less than or equal to 35 per cent (p less than 0.005). Statistically significant correlation between MUGA-derived LVEF and cardiac related mortality was found in veteran patients undergoing noncardiac surgical procedures (both vascular and nonvascular). There was no correlation between MUGA-derived LVEF and postoperative cardiac related mortality in cardiac surgical patients. A preoperative American Society of Anesthesiologists Physical Status Evaluation classification of IV or a preoperative pulmonary capillary wedge pressure of 20 centimeters of water or greater also predicted an increased risk of postoperative cardiac death. We advise preoperative MUGA scans for all patients in whom the results of preoperative history or physical examination suggest compromised ventricular function. We also advise pulmonary arterial catheter hemodynamic monitoring during the perioperative period for all patients with a preoperative MUGA-derived LVEF of less than or equal to 35 per cent.
在三家医院进行了一项回顾性研究，研究对象为196例患者，这些患者在进行放射性核素测定（多门控心血池显像扫描[MUGA]）以检测左心室射血分数（LVEF）后长达60天接受了手术。第1组患者（LVEF大于或等于55%）的心脏相关死亡率为2.2%；第2组患者（LVEF为36%至54%）为5.4%；第3组患者（LVEF小于或等于35%）为19.5%（p<0.005）。在接受非心脏手术（包括血管手术和非血管手术）的老年患者中，发现MUGA测定的LVEF与心脏相关死亡率之间存在统计学显著相关性。在心脏手术患者中，MUGA测定的LVEF与术后心脏相关死亡率之间无相关性。术前美国麻醉医师协会身体状况评估分级为IV级或术前肺毛细血管楔压为20厘米水柱或更高也预示着术后心脏死亡风险增加。我们建议对所有术前病史或体格检查结果提示心室功能受损的患者进行术前MUGA扫描。我们还建议对所有术前MUGA测定的LVEF小于或等于35%的患者在围手术期进行肺动脉导管血流动力学监测。
