Holm C, Christensen M, Rasmussen V, Schulze S, Rosenberg J
Dept. of Surgery, Sundby Hospital, Copenhagen, Denmark.
Scand J Gastroenterol. 1998 Jul;33(7):769-72. doi: 10.1080/00365529850171747.
Myocardial ischaemia (defined as ST-segment deviation on electrocardiogram (ECG)) may occur during colonoscopy, but the pathogenic mechanisms are unknown. We have evaluated the occurrence of arterial hypoxaemia, tachycardia, and myocardial ischaemia during routine colonoscopy.
Eighteen patients underwent colonoscopy under conscious sedation and without supplementary oxygen. Arterial oxygen saturation was measured by continuous pulse oximetry, and ECG was monitored continuously with a Holter tape recorder during the procedure.
Arterial oxygen desaturation and tachycardia were common during colonoscopy and occurred in 45% and 35% of patients, respectively. Two patients developed signs of myocardial ischaemia during the colonoscopy: one case of ST depression (1.7 mV) and one case of ST elevation (4.3 mV). In both patients the ST deviation disappeared when the colonoscope was retracted. Myocardial ischaemia occurred in both patients simultaneously with tachycardia, and in one of these arterial hypoxaemia was also present.
Myocardial ischaemia occurs during routine colonoscopy, but with a lower incidence than previously reported during upper endoscopy. Myocardial ischaemia during colonoscopy may be associated with tachycardia and/or hypoxaemia. Further studies should clarify the relative role of tachycardia, hypoxaemia, and viscerocardiac reflexes in the pathogenesis of myocardial ischaemia during colonoscopy.
结肠镜检查期间可能会发生心肌缺血（定义为心电图（ECG）上的ST段偏移），但其发病机制尚不清楚。我们评估了常规结肠镜检查期间动脉血氧不足、心动过速和心肌缺血的发生情况。
18例患者在清醒镇静且未补充氧气的情况下接受结肠镜检查。通过连续脉搏血氧饱和度测定法测量动脉血氧饱和度，并在检查过程中用动态心电图记录仪连续监测心电图。
结肠镜检查期间动脉血氧饱和度降低和心动过速很常见，分别发生在45%和35%的患者中。两名患者在结肠镜检查期间出现心肌缺血迹象：1例ST段压低（1.7 mV）和1例ST段抬高（4.3 mV）。在两名患者中，当结肠镜撤回时ST段偏移消失。两名患者的心肌缺血均与心动过速同时发生，其中1例还存在动脉血氧不足。
常规结肠镜检查期间会发生心肌缺血，但发生率低于先前报道的上消化道内镜检查期间的发生率。结肠镜检查期间的心肌缺血可能与心动过速和/或血氧不足有关。进一步的研究应阐明心动过速、血氧不足和内脏心反射在结肠镜检查期间心肌缺血发病机制中的相对作用。
