Landesberg Giora, Mosseri Morris, Wolf Yehuda, Vesselov Yellena, Weissman Charles
Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel.
Anesthesiology. 2002 Feb;96(2):264-70. doi: 10.1097/00000542-200202000-00007.
Perioperative myocardial ischemia is conventionally monitored using five electrocardiographic leads, with only one precordial lead placed at V5. This is based on studies from more than a decade ago. The authors reassessed this convention by analyzing data obtained from continuous on-line 12-lead electrocardiographic monitoring.
One hundred eighty-five consecutive patients undergoing vascular surgery were monitored by continuous 12-lead ST-trend analysis during and for 48-72 h after surgery. Cardiac troponin I was measured in the first 3 postoperative days, and cardiac outcome was prospectively recorded. Ischemia was defined as ST deviation, relative to the reference preanesthesia electrocardiogram, of 0.2 mV or more in one lead or 0.1 mV or more in two contiguous leads, lasting more than 10 min.
During 11,132 patient-hours of monitoring, 38 patients (20.5%) had 66 transient ischemic events, with all but one denoted by ST-segment depression. Twelve patients (6.5%) sustained postoperative infarction (cardiac troponin I > 3.1 ng/ml). Among the 38 patients with ischemia, lead V3 most frequently (86.8%) demonstrated ischemia, followed by V4 (78.9%) and V5 (65.8%). Among the 12 patients with infarction, V4 was most sensitive to ischemia (83.3%), followed by V3 and V5 (75% each). Combining two precordial leads increased the sensitivity for detecting ischemia (97.4% for V3 + V5 and 92.1% for either V4 + V5 or V3 + V4) and infarction (100% for V4 + V5 or V3 + V5 and 83.3% for V3 + V4). On average, baseline preanesthesia ST was above isoelectric in V1 through V3 and below isoelectric in V5 through V6. Lead V4 was closest to the isoelectric level on the baseline electrocardiogram, rendering it most suitable for ischemia monitoring.
As a single lead, V4 is more sensitive and appropriate than V5 for detecting prolonged postoperative ischemia and infarction. Two precordial leads or more are necessary so as to approach a sensitivity of greater than 95% for detection of perioperative ischemia and infarction.
围手术期心肌缺血传统上通过五个心电图导联进行监测，仅在V5处放置一个胸前导联。这是基于十多年前的研究。作者通过分析连续在线12导联心电图监测获得的数据，重新评估了这一传统方法。
185例连续接受血管手术的患者在手术期间及术后48 - 72小时通过连续12导联ST段趋势分析进行监测。在术后头3天测量心肌肌钙蛋白I，并前瞻性记录心脏结局。缺血定义为相对于麻醉前参考心电图，一个导联ST段偏移0.2 mV或更多，或两个相邻导联ST段偏移0.1 mV或更多，持续超过10分钟。
在11132患者 - 小时的监测期间，38例患者（20.5%）发生66次短暂性缺血事件，除1次外均表现为ST段压低。12例患者（6.5%）发生术后梗死（心肌肌钙蛋白I > 3.1 ng/ml）。在38例缺血患者中，V3导联最常出现缺血（86.8%），其次是V4（78.9%）和V5（65.8%）。在12例梗死患者中，V4对缺血最敏感（83.3%），其次是V3和V5（均为75%）。联合两个胸前导联可提高检测缺血（V3 + V5为97.4%，V4 + V5或V3 + V4为92.1%）和梗死（V4 + V5或V
