Bhuripanyo K, Prasertchuang C, Viwathanatepa M, Khumsuk K, Sornpanya N
Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
J Med Assoc Thai. 1992 Jul;75(7):399-406.
A 12 lead electrocardiogram (ECG) has been recommended for adult patients before operations involving general or regional anesthesia. However, there is a growing consensus that it is of little benefit and ECG should be done only in selected subsets of patients with cardiac signs and symptoms or older patients. We prospectively surveyed 1,013 patients before operation, 395 patients were 40 years or more, ECG abnormalities were present in 130/395 (32.9%), significant ECG abnormalities in 31/395 (7.9%) and ECG with management change in 10/395 (2.5%). Old or questionable myocardial infarction were found in 8 (4.0%) and acute ischemia or injury in 4 (2.0%). The frequency of ECG abnormalities increased with age in males but not in females. Abnormal physical examination could predict only 20 per cent of abnormal ECG. The variables which could predict ECG abnormalities were age and irregular pulse. The frequency of ECG abnormalities, significant ECG abnormalities and ECG abnormalities which led to management change in those patients with normal physical examination were 31.7, 6.4 and 2.2 per cent respectively. In conclusion we propose that preoperative ECG may be indicated in both men and women aged > or = 40 years.
对于接受全身或区域麻醉手术的成年患者，推荐进行12导联心电图（ECG）检查。然而，越来越多的人达成共识，认为其益处不大，仅应对有心脏体征和症状的特定患者亚组或老年患者进行ECG检查。我们对1013例患者进行了术前前瞻性调查，其中395例患者年龄在40岁及以上，130/395（32.9%）存在ECG异常，31/395（7.9%）存在显著ECG异常，10/395（2.5%）因ECG改变了管理方案。发现8例（4.0%）有陈旧性或可疑心肌梗死，4例（2.0%）有急性缺血或损伤。男性中ECG异常的发生率随年龄增加而升高，女性则不然。体格检查异常仅能预测20%的ECG异常。可预测ECG异常的变量为年龄和脉搏不规则。体格检查正常的患者中，ECG异常、显著ECG异常以及导致管理方案改变的ECG异常的发生率分别为31.7%、6.4%和2.2%。总之，我们建议年龄≥40岁的男性和女性术前均可能需要进行ECG检查。
