Thompson R C, Liberthson R R, Lowenstein E
JAMA. 1985 Nov 1;254(17):2419-21.
To determine their perioperative risk, we reviewed the records of 35 patients with hypertrophic cardiomyopathy diagnosed by cardiac ultrasound and/or catheterization who underwent general (52) or spinal (four) anesthesia--a total of 56 major surgical procedures. There were no operative or related perioperative deaths and no significant ventricular tachyarrhythmias. Intraoperative or postoperative complications included: myocardial infarction with heart failure in one patient who also had coronary artery disease and was one of three patients who had spinal anesthesia, arrhythmia requiring therapy in eight, and angina during supraventricular tachycardia in one. We conclude that the risk of general anesthesia and major noncardiac surgery is low in patients with hypertrophic obstructive cardiomyopathy. Spinal anesthesia, which decreases systemic vascular resistance and increases capacitance, may be relatively contraindicated. Concomitant coronary artery disease may increase the risk.
为确定其围手术期风险，我们回顾了35例经心脏超声和/或心导管检查诊断为肥厚型心肌病的患者的记录，这些患者接受了全身麻醉（52例）或脊髓麻醉（4例）——总共进行了56例大手术。没有手术或相关围手术期死亡病例，也没有明显的室性快速心律失常。术中或术后并发症包括：1例患有冠状动脉疾病且接受脊髓麻醉的患者发生心肌梗死并伴有心力衰竭，该患者是接受脊髓麻醉的3例患者之一；8例需要治疗的心律失常；1例在室上性心动过速期间出现心绞痛。我们得出结论，肥厚型梗阻性心肌病患者接受全身麻醉和非心脏大手术的风险较低。降低体循环血管阻力并增加容量的脊髓麻醉可能相对禁忌。合并冠状动脉疾病可能会增加风险。
