Ouyang P, Gerstenblith G, Furman W R, Golueke P J, Gottlieb S O
Department of Medicine, Francis Scott Key Medical Center, Baltimore, Maryland 21224.
Am J Cardiol. 1989 Nov 15;64(18):1113-6. doi: 10.1016/0002-9149(89)90862-x.
Coronary disease causes the majority of perioperative complications after peripheral vascular surgery. Twenty-four patients with stable coronary disease undergoing peripheral revascularization were studied using continuous electrocardiographic monitoring to determine the incidence of perioperative asymptomatic myocardial ischemia and its relation to postoperative clinical ischemic events. Patients were monitored preoperatively (17 +/- 1 hours), intraoperatively and postoperatively (29 +/- 2 hours) using 4-channel calibrated amplitude-modulated units. Fifteen patients (63%) had early postoperative silent ischemia; 3 also had preoperative silent ischemia and 5 intraoperative transient ischemia. Patients with and without silent ischemia had similar clinical characteristics, perioperative antianginal medications and postoperative episodes of hemodynamic instability. However, 8 of 15 patients (53%) with silent ischemia had postoperative clinical ischemic events (2 had myocardial infarction, 2 had new congestive heart failure and 4 had new rest angina), versus only 1 of 9 patients (11%) without silent ischemia who had angina (p less than 0.05). Early postoperative silent myocardial ischemia occurs frequently after vascular surgery and is associated with postoperative clinical ischemic events.
冠心病是外周血管手术后围手术期并发症的主要原因。对24例接受外周血管重建术的稳定型冠心病患者进行了连续心电图监测，以确定围手术期无症状心肌缺血的发生率及其与术后临床缺血事件的关系。使用4通道校准调幅装置对患者进行术前（17±1小时）、术中及术后（29±2小时）监测。15例患者（63%）术后早期出现无症状缺血；3例术前也有无症状缺血，5例术中出现短暂性缺血。有无无症状缺血的患者在临床特征、围手术期抗心绞痛药物使用及术后血流动力学不稳定发作方面相似。然而，15例无症状缺血患者中有8例（53%）发生术后临床缺血事件（2例发生心肌梗死，2例出现新发充血性心力衰竭，4例出现新发静息性心绞痛），而9例无无症状缺血患者中仅有1例（11%）发生心绞痛（p<0.05）。血管手术后常发生术后早期无症状心肌缺血，且与术后临床缺血事件相关。
