Wilcox C M, Faibicher M, Wenger N K, Shalek K A
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Ga.
Arch Intern Med. 1993 Oct 25;153(20):2325-30.
Since the introduction of gastrointestinal tract endoscopic procedures, there has been concern about cardiovascular complications, especially in patients with coronary heart disease. Although, in general, these procedures are safe, previous studies have documented perturbations in blood pressure, heart documented perturbations in blood pressure, heart rate, and oxygen saturation, as well as the occurrence of arrhythmias and nonspecific ST-segment electrocardiographic changes during such procedures. No studies, however, have specifically addressed the prevalence of silent myocardial ischemia and arrhythmias in patients with well-established coronary heart disease.
During a 15-month period, 25 hospitalized patients with well-defined coronary heart disease underwent continuous ambulatory electrocardiographic recording during endoscopic procedures requiring intravenous sedation, as well as during a prolonged baseline period. All patients were considered clinically stable, although 92% were categorized as being at intermediate or high coronary risk by standard risk stratification criteria. Eleven patients (44%) had had previous myocardial infarction, and 68% reported a history of angina.
Although 24% of patients had one or more episodes of electrocardiographic ischemia during the recording periods, no patient had evidence of ischemia exclusively during the endoscopic procedure. Arrhythmias were no more frequent during the endoscopic procedures than during a corresponding baseline period. Symptomatic angina or serious arrhythmias did not occur during the procedures.
Our data suggest that endoscopic procedures in patients with stable but severe coronary heart disease, when performed with standard medications, monitoring, and techniques, rarely result in silent or symptomatic myocardial ischemia or serious arrhythmias. In addition, although asymptomatic minor arrhythmias are common during endoscopic procedures, their occurrence appears less frequent than during daily hospital life.
自从胃肠道内镜检查术问世以来，人们一直担心其心血管并发症，尤其是冠心病患者。尽管一般来说，这些检查是安全的，但既往研究记录了此类检查过程中血压、心率和血氧饱和度的波动，以及心律失常和非特异性ST段心电图改变的发生情况。然而，尚无研究专门探讨确诊冠心病患者无症状心肌缺血和心律失常的发生率。
在15个月期间，25例确诊冠心病的住院患者在需要静脉镇静的内镜检查过程中以及较长的基线期内接受了动态心电图连续记录。所有患者临床情况均稳定，不过按照标准风险分层标准，92%的患者被归类为冠状动脉中度或高度风险。11例患者（44%）曾有过心肌梗死，68%的患者有过心绞痛病史。
尽管24%的患者在记录期间有一次或多次心电图缺血发作，但没有患者仅在内镜检查过程中有缺血证据。内镜检查过程中心律失常的发生率并不高于相应的基线期。检查过程中未发生症状性心绞痛或严重心律失常。
我们的数据表明，对于病情稳定但严重的冠心病患者，在内镜检查时采用标准药物、监测和技术，很少会导致无症状或有症状的心肌缺血或严重心律失常。此外，尽管内镜检查过程中无症状性轻度心律失常很常见，但其发生率似乎低于住院期间的日常发生率。
