Roggenbach J, Böttiger B W, Teschendorf P
Klinik für Anaesthesiologie und Intensivmedizin, Klinikum der Universität Heidelberg, Im Neuenheimer Feld 110, 69115, Heidelberg.
Anaesthesist. 2009 Jul;58(7):665-76. doi: 10.1007/s00101-009-1577-1.
Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. However, in many cases the clinical presentation does not allow a clear differentiation between ischemic and non-ischemic myocardial damage. In the majority of cases perioperative myocardial infarctions occur with only mild or even without any clinical symptoms. This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury.
围手术期心肌损伤的发生率很高，这取决于手术操作和所检查的患者，并且被认为是接受非心脏手术患者围手术期发病率和死亡率增加的最相关危险因素之一。围手术期心肌损伤的病理生理学仍未得到很好的理解。伴有或不伴有急性冠状动脉闭塞的缺血以及非缺血性刺激在围手术期都会给心脏带来巨大压力。然而，在许多情况下，临床表现无法明确区分缺血性和非缺血性心肌损伤。在大多数情况下，围手术期心肌梗死仅表现为轻微症状，甚至没有任何临床症状。这可能是由于围手术期和非围手术期心肌梗死在表型和病理生理学上存在相当大的差异。由于围手术期心肌梗死的病因不明，对于急性冠状动脉综合征的当代诊断和治疗建议是否可以外推至围手术期情况仍是一个悬而未决的问题。本综述反映了当前的知识状态，并提出了一种围手术期心肌损伤诊断和治疗的可选方法。
