冠心病患者及接受非心脏手术的冠心病“高危”患者围手术期心肌梗死。

Perioperative myocardial infarction in coronary artery disease patients and 'at-risk' for coronary artery disease patients undergoing non-cardiac surgery.

作者信息

Varma M K, Puri G D, Chari P, Verma J S, Kohli K K

机构信息

Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

Natl Med J India. 1996 Sep-Oct;9(5):214-7.

PMID:8937059

Abstract

BACKGROUND

Perioperative myocardial infarction (POMI) carries a high mortality and occurs more commonly in patients with a history of coronary artery disease (CAD). However, there are also other patients undergoing surgery who are 'at risk' for CAD but who do not have a history of infarction or angina. We compared the incidence of POMI in these two groups.

METHODS

In a prospective study of 69 men and 39 women over 30 years of age undergoing non-cardiac surgery under general or regional anaesthesia, 56 had definite CAD and 52 were 'at-risk' for CAD. All these patients were followed up with serial postoperative electrocardiography and CK-MB isoenzyme analysis for the diagnosis of POMI.

RESULTS

The POMI rate was 32% in definite CAD patients and 15% in patients 'at-risk' for CAD. Mortality in patients with POMI was 17% in those with CAD and 13% in those 'at-risk' for CAD. Perioperative myocardial infarction was maximal in the first 24 hours following surgery (77%). All the POMIs were painless. Anaesthesia techniques--whether regional or general--did not influence the incidence of POMI (Chi-square, p > 0.05). The type of drugs used in the treatment of CAD such as beta-blockers, calcium channel blockers and antiplatelet agents did not cause any difference in the incidence of POMI (Chi-square, p > 0.05). Patients who had either an intraoperative hypertensive episode, tachycardia, arrhythmias or ST-segment changes had a higher incidence of POMI (Chi-square, p > 0.05). The incidence of POMI was not lower in patients undergoing transurethral resection of the prostate compared to patients undergoing other types of non-cardiac surgery (Chi-square, p > 0.05).

CONCLUSION

POMI occurs in one-third of patients with a history of CAD and one-sixth of those 'at-risk'. It carries a mortality of 17% and 13% respectively. Decisions to operate on such patients should be taken with caution.

摘要

背景

围手术期心肌梗死（POMI）死亡率高，在有冠状动脉疾病（CAD）病史的患者中更常见。然而，也有其他接受手术的患者有患CAD的“风险”，但没有梗死或心绞痛病史。我们比较了这两组患者中POMI的发生率。

方法

在一项对69名男性和39名30岁以上接受全身或区域麻醉下非心脏手术的女性进行的前瞻性研究中，56例有明确的CAD，52例有患CAD的“风险”。所有这些患者术后均进行连续心电图和CK-MB同工酶分析以诊断POMI。

结果

明确CAD患者的POMI发生率为32%，有患CAD“风险”的患者为15%。POMI患者中CAD患者的死亡率为17%，有患CAD“风险”的患者为13%。围手术期心肌梗死在术后最初24小时内最为常见（77%）。所有POMI均为无痛性。麻醉技术——无论是区域麻醉还是全身麻醉——均不影响POMI的发生率（卡方检验，p>0.05）。用于治疗CAD的药物类型，如β受体阻滞剂、钙通道阻滞剂和抗血小板药物，在POMI发生率上没有任何差异（卡方检验，p>0.05）。术中出现高血压发作、心动过速、心律失常或ST段改变的患者POMI发生率较高（卡方检验，p>0.05）。与接受其他类型非心脏手术的患者相比，经尿道前列腺切除术患者的POMI发生率并不低（卡方检验，p>0.05）。