Relationship between Perioperative Risk and Cardio-Respiratory Fitness after Coronary Artery Bypass Grafting

冠狀動脈繞道手術病人手術風險與心肺適能之相關性研究

邱正民(Cheng-Ming Chiu) ； 陳冠誠(Kuan-Cheng Chen) ； 王嘉鐸(Chia-To Wang) ； 周正亮(Chen-Liang Chou)

《台灣復健醫學雜誌》 43卷2期 (2015/06) Pp. 83-89

https://doi.org/10.6315/2015.43(2)02

摘要

前言：European System for Cardiac Operative Risk Evaluation II（EuroSCORE II）是一個用來評估心臟手術術後三十天死亡率的預測模型，它的信效度已在許多研究中獲得證實。在接受冠狀動脈繞道手術的病人中，心肺適能Cardio-respiratory fitness（CRF）已被證實為一個長期存活率的預測因子。然而，接受心臟手術的風險和心肺適能間的關係卻未被研究討論。本實驗目的研究在冠狀動脈手術病人接受心臟手術的風險和心肺適能間的關係。研究方法：這是一個回溯性研究，透過收集在2012年1月到2013年12月間於台北榮民總醫院接受冠狀動脈繞道手術的病人資料，我們找出曾在出院後四週內完成運動心肺功能測試的病人。透過電子病歷收集術前資料，換算出EuroSCORE II的分數，並以跑步機運動心肺功能測試結果的MET值來評估心肺適能。研究結果：29個病人被納入分析。其中有25位男性和4位女性。分析結果，平均MET值是4.92±1.34，代表手術風險的EuroSCORE II平均值為1.52±0.96 %。以最大MET值代表的心肺適能和EuroSCORE II所代表的手術風險間呈中度負相關。（Spearman's correlation p=-0.508, p=0.005）結論：本實驗發現在接受冠狀動脈繞道手術的病人中，接受手術的風險與心肺適能呈負相關。因此對EuroSCORE II較高的病人族群，術後應積極接受phaseI和phaseII的心肺復健。對於其他的心臟手術是否能用EuroSCORE II來評估心肺適能，尚待未來更進一步的研究。

關鍵字

手術風險 ； 心肺適能 ； 心肺運動測試（CPET） ； 冠狀動脈繞道手術（CABG） ； euro SCOREII分數

並列摘要

Introduction and objectives: The European System for Cardiac Operative Risk Evaluation II (euroSCORE II) is a validated model for predicting perioperative mortality after cardiac surgery. The role of cardio-respiratory fitness (CRF), expressed as peak metabolic equivalents (METs), as a predictor of long-term survival in patients who have previously undergone coronary artery bypass grafting (CABG) is well established. However, the correlation between perioperative risk and CRF has not been evaluated. The aim of this study was to investigate the relationship between perioperative risk and CRF in patients after CABG. Methods: Patients who underwent CABG from January 2012 through December 2013 at VGH-TPE were queried, and those who completed cardiopulmonary exercise testing (CPET) around four weeks after discharge from the hospital were enrolled. Electronic medical records were reviewed to calculate euroSCORE II. Peak METs established by treadmill was used to measure CRF. Results: Twenty-nine patients (25 males+4 females) were included. The mean peak MET was 4.92±1.34, and the mean perioperative risk of mortality measured by euroSCORE II was 1.52±0.96%. An inverse correlation between peak MET and perioperative risk was identified (Spearman's correlation p=-0.508, p=0.005) Conclusions: The present study provides information not previously found in the literature that euroSCORE II is correlated with CRF in patients after CABG. For those with a higher euroSCORE II, aggressive phase I and phase II cardiac rehabilitation are indicated. Further studies to justify the use of euroSCORE II as an indicator of CRF in other disease categories are warranted.

並列關鍵字

Perioperative risk ； Cardio-respiratory fitness ； Cardiopulmonary exercise testing (CPET) ； Coronary artery bypass grafting (CABG) ； The European System for Cardiac Operative Risk Evaluation II (euroSCORE II)

參考文獻

洪毓陽，洪素鶯，周正亮，陳適安:台灣臨床成效指標系統施行後急性心肌梗塞經心導管介入之患者接受心臟復健現況。台灣復健醫學雜誌 2014;42:153 -60.

Blair SN, Kampert JB, Kohl HW 3rd, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205-10.

Wei M, Kampert JB, Barlow CE, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999;282:1547-53.

Smith JL, Verrill TA, Boura JA, et al. Effect of cardiorespiratory fitness on short-term morbidity and mortality after coronary artery bypass grafting. Am J Cardiol 2013;112:1104-9

Davis JA Direct determination of aerobic power. In: Maud PJ, Foster C, editors. Physiological assessment of human fitness. Human Kinetics, Champaign IL; 1995. p.9-17.