Preoperative assessment value of treadmill experimental Duke score of coronary artery disease in patients with non-cardiac surgery / 中国综合临床

ABSTRACT

Objective To analysis of treadmill exercise test Duke score(DTS) in patients with coronary heart disease than the evaluation functions of heart operation perioperative cardiac events.Methods One hundred and eighty-four patients with coronary heart disease,45 ～ 75 years of medium-sized non cardiac operation,were chose from May,2010 to May,2011 in our hospital,Cardiac ultrasound,treadmill exercise test were taken before operation,preoperative examination department of internal medicine disease history and physical examinations.According to the Duke score,they were divided into DTS in low risk group (5 ≤ Duke ≤ 15,n =124),medium risk group DTS(DTS(-10≤Duke≤5,n =60),the exclusions of patients with high-risk DTS group,and the high-risk group of patients were excluded.Comparative analysis of operations,the main type of Department of internal medicine disease history,intraoperative and postoperative major cardiovascular complications.Results In the two groups of operation type and the type of anesthesia and cardiovascular disease,there is no significant difference (P ＞ 0.05) ; in DTS low risk group the age (59.2 ± 4.1) years,preoperative cardiac dysfunction were 2 cases,left ventricular ejection fraction ＜ 0.50 were 2 case (1.6％),diabetes history 12 case(9.6％),with angina pectoris symptoms of 51 case(41.1％),ECG ischemic changes in 55 (44.3 ％),in the medium DTS risk group,the age(65.2 ± 2.6)years,preoperative cardiac dysfunction were 8 cases(13.3％),left ventricular ejection fraction of ＜ 0.50 was 5 case (8.3％),diabetes history 23 case (38.3 ％),angina pectoris and 60 case (100％),ECG ischemic changes in 40 case (66.7 ％) (t =2.98,P =0.042,x2 values were 4.93,3.84,4.67,5.24,3.58,P ＜0.05).The low risk group of patients with arrhythmia,hypertension incidence rate were 6.5％ (8/124) and 22.5％ (28/124),medium risk group of patients with arrhythmia,hypertension incidence rate were 11.6％ (7/60) and 18.3％ (11/60),compared with DTS in low risk group,DTS medium risk group of arrhythmia and hypertension odds ratio(Odds Ratio,OR) and 95％ confidence intervals were 1.7 (0.8-3.3),0.8 (0.4-1.4),the P values were 0.062,0.074,has no significant difference.Controlling for age and sex DTS in low risk group postoperative myocardial infarction,cardiogenic pulmonary edema rate were 0.8％ (1/124) and 2.4％ (3/124),medium risk group after DTS myocardial infarction,cardiogenic pulmonary edema rate were 10％ (6/60) and 11.7％ (7/60),compared with DTS in low risk group,DTS medium risk group after myocardial infarction and heart pulmonary edema ratios (Odds Ratio,OR) and 95％ confidence intervals were 19.3 (5.6-66.2),5.7 (2.5-12.9),the P values were 0.002,0.003,had significant diflerence.Conclusion DTS medium risk group patients undergoing non cardiac operation preoperative heart failure,diabetes,angina symptoms,peri operation period of cardiac event rate is high and heavy.