肿瘤患者合并冠心病的临床管理策略

Clinical management strategy for cancer patients concomitant with coronary artery disease

摘要:

当前同时患有肿瘤和冠心病的患者日益增多,肿瘤患者合并冠心病的临床管理策略成为目前肿瘤心脏病学中的热点问题。相对于传统冠心病的发病机制,肿瘤合并冠心病的患者存在一些与肿瘤发病及治疗相关的特殊机制,给此类患者的临床管理带来挑战。对于这类患者,既要对肿瘤和冠心病进行综合治疗,以同时降低恶性肿瘤及并存的冠心病的发病率和死亡率,又要评估肿瘤和冠心病对于患者生命的危险程度,以决定选择首先接受肿瘤切除术,或是冠状动脉介入治疗后再行肿瘤手术治疗,以及术前术后如何科学干预以降低综合风险,这些都是目前临床上救治肿瘤合并冠心病患者的难点。本文对肿瘤患者合并冠心病的发病机制、冠心病的综合管理、冠状动脉介入治疗的管理以及肿瘤手术前冠心病的评估与管理的优化方案等诸多方面的研究进展进行综述,以期为肿瘤患者合并冠心病的临床管理策略制定提供参考依据。

Abstract:

Cancer patients with concomitant coronary artery disease have been increasing, whose clinical management strategy has drawn much focus in oncology and cardiology. Different from pathophysiological mechanisms of coronary artery disease alone, cancer concomitant with coronary artery disease has unique pathophysiological mechanisms associated with oncogenesis and cancer treatment, posing challenges for the clinical management of such patients. First, comprehensive treatment for cancer and coronary artery disease has to be balanced with consideration of reducing morbidity and mortality due to the two diseases. Second, individual threat of the two diseases to the patient′s life has to be weighed to determine the choice between surgery for cancer removal first or intervention for coronary artery disease first followed by surgery for cancer removal. Moreover, pre- and post-operative interventions have to be considered to reduce overall risk. Those are all difficulties in clinical management of the cancer patients with coronary heart disease. This article reviews the pathogenesis of cancer patients with coronary artery disease, comprehensive management of coronary artery disease, management of coronary intervention, and optimization of evaluation and management of coronary artery disease before surgery for cancer removal, providing reference for clinical management strategy for cancer patients with coronary artery disease.