Tseng Ping-Huei, Liou Jyh-Ming, Lee Yi-Chia, Lin Lian-Yu, Yan-Zhen Liu Alyssa, Chang Dun-Cheng, Chiu Han-Mo, Wu Ming-Shiang, Lin Jaw-Town, Wang Hsiu-Po
Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County 640, Taiwan.
Am J Emerg Med. 2009 Sep;27(7):802-9. doi: 10.1016/j.ajem.2008.06.018.
Endoscopy is useful for diagnosis and treatment of upper gastrointestinal bleeding (UGIB). However, both endoscopy and UGIB may compromise the cardiovascular function. The present study is to investigate the cardiovascular responses of emergency endoscopy for patients with UGIB and stable coronary artery disease (CAD).
Consecutive 50 patients with known CAD and 50 patients without CAD history (non-CAD group) in whom emergency endoscopy was requested for UGIB were prospectively enrolled. All patients received ambulatory electrocardiographic monitoring before, during, and after endoscopies. Cardiac indices including supraventricular and ventricular arrhythmia, ST ischemic change, and autonomic nervous function evaluated by heart rate variability were compared.
All patients in both groups had successful primary hemostasis, and peptic ulcer bleeding was the main etiology (82%). Compared with the non-CAD group, patients with CAD had a significantly higher incidence (42% vs 16%, P = .004) and frequency (1.19 vs 0.12 events per minute, P = .003) of ventricular arrhythmias during endoscopy. Nine patients with CAD and 1 patient without CAD had ischemic ST changes (P = .016). Comorbidity with congestive heart failure was not only associated with a higher frequency (P = .02) but also a more severe fluctuation (P = .002) of ventricular arrhythmia. None in both groups had angina or MI before, during, or after endoscopy. Heart rate variability did not show a difference.
Ventricular arrhythmias and myocardial ischemia, although mostly subclinical, were common in patients with stable CAD undergoing emergent endoscopy for UGIB, especially in those with concomitant congestive heart failure.
内镜检查对上消化道出血（UGIB）的诊断和治疗很有用。然而，内镜检查和UGIB都可能损害心血管功能。本研究旨在调查UGIB合并稳定型冠状动脉疾病（CAD）患者进行急诊内镜检查时的心血管反应。
前瞻性纳入连续50例已知CAD患者和50例无CAD病史患者（非CAD组），这些患者因UGIB需要进行急诊内镜检查。所有患者在胃镜检查前、检查期间和检查后均接受动态心电图监测。比较包括室上性和室性心律失常、ST段缺血性改变以及通过心率变异性评估的自主神经功能等心脏指标。
两组所有患者均成功实现初步止血，消化性溃疡出血是主要病因（82%）。与非CAD组相比，CAD患者在内镜检查期间室性心律失常的发生率（42%对16%，P = 0.004）和频率（每分钟1.19次对0.12次事件，P = 0.003）显著更高。9例CAD患者和1例非CAD患者出现ST段缺血性改变（P = 0.016）。合并充血性心力衰竭不仅与室性心律失常的频率较高（P = 0.02）有关，而且与更严重的波动（P = 0.002）有关。两组患者在胃镜检查前、检查期间或检查后均未出现心绞痛或心肌梗死。心率变异性没有差异。
室性心律失常和心肌缺血虽然大多为亚临床状态，但在因UGIB接受急诊内镜检查的稳定型CAD患者中很常见，尤其是那些合并充血性心力衰竭的患者。
