Cappell M S, Iacovone F M
Department of Medicine, Maimonides Medical Center, Brooklyn, New York 11219, USA.
Am J Med. 1999 Jan;106(1):29-35. doi: 10.1016/s0002-9343(98)00363-5.
To analyze the risks versus benefits of esophagogastroduodenoscopy performed soon after myocardial infarction.
We studied 200 patients who underwent endoscopy within 30 days after myocardial infarction with 200 controls matched for age, sex, and endoscopic indication who underwent endoscopy without a history of myocardial infarction within the prior 6 months. Odds ratios (OR) and 95% confidence intervals (CI) are reported.
The indications for endoscopy included hematemesis in 88, melena in 43, fecal occult blood and anemia in 33, red blood per rectum in 13, abdominal pain in 13, and other indications in 10. Endoscopy was performed a mean (+/- SD) of 9.1 +/- 8.9 days after myocardial infarction, was diagnostic in 85% of all the patients, and was more frequently diagnostic when performed for hematemesis or melena than when performed for other indications (92% vs 71%, P <0.0003). Common diagnoses included duodenal ulcer, gastric ulcer, gastritis, and esophagitis. Fifteen post-myocardial infarction patients (7.5%) suffered endoscopic complications, including fatal ventricular tachycardia (n = 1), near respiratory arrest (n = 1), mild hypotension (n = 11), and moderate hypoxemia (n = 2), compared with three patients (1.5%) in the control group (OR = 5.3, CI = 1.5 to 19). Patients who had endoscopic complications after myocardial infarction had a significantly higher APACHE II score than those who did not (mean score of 17.3 +/- 5.8 vs 11.7 +/- 5.7, P <0.001). Endoscopic complications occurred in 21% (12 of 58) of post-myocardial infarction patients who were very ill (APACHE II score > or = 16) but in only 2% (3 of 142) of those whose condition was relatively stable (APACHE II score < or = 15, OR = 12; CI = 3.3 to 45). Hypotension before endoscopy and a high APACHE II score were independent risk factors for complications in post-myocardial infarction patients.
Relatively stable patients with upper gastrointestinal bleeding and recent myocardial infarction can and should undergo esophagogastroduodenoscopy. Most endoscopic complications in these patients are cardiopulmonary, and they generally occur in very ill patients.
分析心肌梗死后不久进行食管胃十二指肠镜检查的风险与获益。
我们研究了200例在心肌梗死后30天内接受内镜检查的患者，并与200例年龄、性别和内镜检查指征相匹配的对照者进行比较，这些对照者在过去6个月内无心肌梗死病史且接受了内镜检查。报告比值比（OR）和95%置信区间（CI）。
内镜检查的指征包括呕血88例、黑便43例、粪便潜血和贫血33例、直肠便血13例、腹痛13例以及其他指征10例。内镜检查在心肌梗死后平均（±标准差）9.1±8.9天进行，在所有患者中85%具有诊断价值，因呕血或黑便进行内镜检查时比因其他指征进行检查时更常具有诊断价值（92%对71%，P<0.0003）。常见诊断包括十二指肠溃疡、胃溃疡、胃炎和食管炎。15例心肌梗死后患者（7.5%）发生内镜检查并发症，包括致命性室性心动过速（n = 1）、近乎呼吸骤停（n = 1）、轻度低血压（n = 11）和中度低氧血症（n = 2），而对照组有3例患者（1.5%）发生并发症（OR = 5.3，CI = 1.5至19）。心肌梗死后发生内镜检查并发症的患者的急性生理与慢性健康状况评分系统（APACHE II）评分显著高于未发生并发症的患者（平均评分17.3±5.8对11.7±5.7，P<0.001）。在病情非常严重（APACHE II评分≥16）的心肌梗死后患者中，21%（58例中的12例）发生内镜检查并发症，但在病情相对稳定（APACHE II评分≤15）的患者中仅2%（142例中的3例）发生并发症（OR = 12；CI = 3.3至45）。内镜检查前的低血压和高APACHE II评分是心肌梗死后患者发生并发症的独立危险因素。
患有上消化道出血且近期发生心肌梗死的相对稳定患者能够且应该接受食管胃十二指肠镜检查。这些患者中的大多数内镜检查并发症是心肺方面的，且通常发生在病情非常严重的患者中。
