Thomson I R
Department of Anesthesia, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
J Cardiothorac Vasc Anesth. 1994 Oct;8(5):593-5. doi: 10.1016/1053-0770(94)90177-5.
The principal importance of intraoperative ischemia is its consistent association with adverse outcome. In coronary artery surgery the finding of prebypass ischemia is an important predictor, and postbypass ischemia is a critical predictor of adverse outcome. One in three patients with postbypass ischemia will suffer an adverse outcome in CABG. Furthermore, prevention of postbypass ischemia may improve outcome in CABG. Clearly, intraoperative ischemia in CABG surgery is an ominous sign that should be regarded with the utmost concern by anesthesiologists. In noncardiac surgery, intraoperative ischemia also indicates about a one in three chance of adverse outcome. Although it is less sensitive than postoperative ischemia, it may have superior positive predictive power and specificity. Most importantly, intraoperative monitoring for ischemia is currently available to most patients, whereas extended postoperative monitoring is not. The finding of intraoperative ischemia defines a high-risk group of patients who may merit special monitoring and treatment. To regard intraoperative ischemia as benign would be inconsistent with available information.
术中缺血的主要重要性在于它始终与不良预后相关。在冠状动脉手术中，体外循环前缺血的发现是一个重要的预测指标，而体外循环后缺血是不良预后的关键预测指标。在冠状动脉搭桥手术（CABG）中，三分之一的体外循环后缺血患者会出现不良预后。此外，预防体外循环后缺血可能会改善CABG的预后。显然，CABG手术中的术中缺血是一个不祥之兆，麻醉医生应给予最大程度的关注。在非心脏手术中，术中缺血也提示约有三分之一的不良预后几率。虽然它比术后缺血的敏感性低，但可能具有更高的阳性预测价值和特异性。最重要的是，目前大多数患者都可进行术中缺血监测，而术后的长期监测则不然。术中缺血的发现确定了一组可能值得进行特殊监测和治疗的高危患者。将术中缺血视为良性与现有信息不符。
