Ashton C M, Thomas J, Wray N P, Wu L, Kiefe C I, Lahart C J
General Medicine Section, Veterans Affairs Medical Center, Houston, TX 77030.
J Am Geriatr Soc. 1991 Jun;39(6):575-80. doi: 10.1111/j.1532-5415.1991.tb03596.x.
Although many clinicians routinely recommend a base-line preoperative electrocardiogram (ECG) and obtain frequent postoperative ECGs to screen for myocardial infarction or ischemia, the diagnostic utility of screening perioperative ECGs is unknown. The present analysis evaluates the sensitivity and specificity of the perioperative ECG and examines its value as a predictor of early postoperative cardiac events and outcomes during the postoperative year. ECGs obtained preoperatively and on the first 3 postoperative days in 206 men undergoing transurethral prostate resection were analyzed using the Minnesota Code. The occurrence of cardiac events during the operative stay was assessed by measurement of the cardiospecific MB creatine kinase isoenzyme on the first 3 postoperative days and review of the entire clinical course. Twenty-one percent of patients developed postoperative ECG changes, mostly involving the T wave; none had cardiac symptoms or sustained creatine kinase MB elevation. Changes were not significantly more common in men known to have coronary disease. The single patient who had a perioperative myocardial infarction confirmed by enzymes had no codable ECG changes. The specificity of any ECG change for perioperative infarction was 78%; of ST segment changes only, 95%. Only one of the patients (2%) who had postoperative ECG changes had a cardiac event in the year after surgery. Routine perioperative ECGs is of little diagnostic/predictive utility in situations in which the incidence of perioperative myocardial infarction is low.
尽管许多临床医生通常会建议进行术前基线心电图（ECG）检查，并在术后频繁进行心电图检查以筛查心肌梗死或缺血情况，但围手术期心电图筛查的诊断效用尚不清楚。本分析评估了围手术期心电图的敏感性和特异性，并检验其作为术后早期心脏事件及术后一年内结局预测指标的价值。采用明尼苏达编码分析了206例接受经尿道前列腺切除术男性患者术前及术后前3天的心电图。通过术后前3天测量心肌特异性肌酸激酶同工酶MB以及回顾整个临床过程来评估手术期间心脏事件的发生情况。21%的患者出现术后心电图改变，主要累及T波；无人有心脏症状或肌酸激酶MB持续升高。已知患有冠心病的男性患者中，心电图改变并无明显更常见。通过酶学检查确诊有围手术期心肌梗死的唯一1例患者，心电图无可编码改变。任何心电图改变对围手术期梗死的特异性为78%；仅ST段改变时为95%。术后有心电图改变的患者中，仅1例（2%）在术后一年发生了心脏事件。在围手术期心肌梗死发生率较低的情况下，常规围手术期心电图检查几乎没有诊断/预测效用。
