Moore C H, Gordon F T, Allums J A, Reeves T J, Lombardo T A, Barclay G W, Brady A B, Sweet R L
Ann Thorac Surg. 1977 Oct;24(4):323-9. doi: 10.1016/s0003-4975(10)63407-8.
The diagnosis of perioperative myocardial infarction (POMI) in patients undergoing coronary artery bypass is uncertain because the criteria of infarction are unclear. Fifty patients who underwent coronary artery bypass were evaluated preoperatively and postoperatively with serial ECGs, creatine phosphokinase (CPK), isoenzyme determinations, and technetium pyrophosphate myocardial scans. Clinical evaluation correlated with exercise testing and postoperative angiography supported the diagnosis in questionable cases. Thirty-five patients (70%) had no evidence of POMI by any criteria, and 2 patients (4%) had unequivocal evidence of infarction by all criteria. Our studies indicate the complexities of diagnosing POMI. We believe that the serially recorded ECG is the most useful diagnostic technique. CPK isoenzyme determinations may be useful but are difficult to interpret in the operative setting. Preoperative cardiac scans are necessary so as to avoid a high incidence of false-positive scans postoperatively. In doubtful cases, postoperative coronary arteriography and left ventricular angiography may provide the most definitive information.
由于心肌梗死的诊断标准尚不明确，冠状动脉搭桥手术患者围手术期心肌梗死（POMI）的诊断存在不确定性。对50例行冠状动脉搭桥手术的患者在术前和术后进行了系列心电图、肌酸磷酸激酶（CPK）、同工酶测定以及焦磷酸锝心肌扫描评估。在可疑病例中，临床评估与运动试验及术后血管造影结果相结合支持了诊断。35例患者（70%）无论依据何种标准均无POMI证据，2例患者（4%）依据所有标准均有明确的梗死证据。我们的研究表明了诊断POMI的复杂性。我们认为，连续记录的心电图是最有用的诊断技术。CPK同工酶测定可能有用，但在手术环境中难以解释。术前心脏扫描是必要的，以避免术后假阳性扫描的高发生率。在可疑病例中，术后冠状动脉造影和左心室造影可能提供最确切的信息。
