Cappell M S
Department of Medicine, UMDNJ Robert Wood Johnson (formerly Rutgers) Medical School, New Brunswick.
Am J Gastroenterol. 1993 Mar;88(3):344-50.
The risks versus benefits of panendoscopy performed soon after myocardial infarction were studied. At Robert Wood Johnson University Hospital from January 1986 through December 1991 and at Princeton Medical Center from January 1990 through December 1991, 82 patients developed overt gastrointestinal bleeding (1.2% of all myocardial infarctions) and 14 patients developed occult gastrointestinal bleeding (0.2% of all myocardial infarctions) within 3 weeks after myocardial infarction. Thirty-four of the patients underwent 42 panendoscopies within 3 weeks of myocardial infarction. Indications for the initial endoscopy included hematemesis in 25, melena without hematemesis in four, red blood per rectum in three, and occult blood in the stool in two. The initial panendoscopy, on average, was performed 6.2 +/- 7.5 (SD) days after myocardial infarction. The 34 initial panendoscopies provided the diagnosis in 27 (79%), and clinically helpful information in four (12%). Common diagnoses were duodenal ulcer in 11, hemorrhagic gastritis in four, and hemorrhagic esophagitis in three. Three complications were due to the initial endoscopy, including fatal ventricular tachycardia, near respiratory arrest, and hypotension. These complications occurred in three (37.5%) of eight patients who were significantly unstable before endoscopy. No (0%) complications occurred in the 26 relatively clinically stable patients undergoing the initial endoscopy. This difference in complication rate was statistically significant (p < 0.01, Fisher's exact test). We conclude that recent myocardial infarction is not an absolute contraindication to panendoscopy. In this retrospective study, the benefits exceeded the risks of panendoscopy in medically stable patients with significant gastrointestinal bleeding. Panendoscopy should be performed with monitoring by electrocardiography and pulse oximetry after stabilization of vital signs, which may require transfusion of blood products, supplemental oxygen administration, endotracheal intubation, and mechanically assisted ventilation. Panendoscopy in highly unstable patients had a high complication rate in this study.
研究了心肌梗死后不久进行全内镜检查的风险与益处。在1986年1月至1991年12月期间的罗伯特·伍德·约翰逊大学医院以及1990年1月至1991年12月期间的普林斯顿医疗中心，82例患者在心肌梗死后3周内出现明显胃肠道出血（占所有心肌梗死的1.2%），14例患者出现隐匿性胃肠道出血（占所有心肌梗死的0.2%）。34例患者在心肌梗死后3周内接受了42次全内镜检查。初次内镜检查的指征包括呕血25例、无呕血的黑便4例、直肠便血3例以及大便潜血2例。初次全内镜检查平均在心肌梗死后6.2±7.5（标准差）天进行。34次初次全内镜检查中，27例（79%）明确了诊断，4例（12%）提供了临床有用信息。常见诊断为十二指肠溃疡11例、出血性胃炎4例、出血性食管炎3例。3例并发症归因于初次内镜检查，包括致命性室性心动过速、近乎呼吸骤停和低血压。这些并发症发生在8例内镜检查前明显不稳定的患者中的3例（37.5%）。26例相对临床稳定的患者进行初次内镜检查时未发生（0%）并发症。并发症发生率的这种差异具有统计学意义（p<0.01，Fisher精确检验）。我们得出结论，近期心肌梗死并非全内镜检查的绝对禁忌证。在这项回顾性研究中，对于有明显胃肠道出血且病情稳定的患者，全内镜检查的益处超过风险。应在生命体征稳定后，通过心电图和脉搏血氧饱和度监测进行全内镜检查，这可能需要输注血液制品、给予补充氧气、气管插管和机械辅助通气。在本研究中，高度不稳定患者进行全内镜检查的并发症发生率很高。
