内镜检查115例心脏并发症的病因分析

Cause analysis of cardiac complications during gastroscopy

目的探讨内镜检查时心脏并发症的病因。方法本文观察了115例患者内镜检查前、中、后的心电图和血压。结果插镜时所有患者血压升高,心率加快,恶心、呕吐越严重变化越明显。110例患者拔镜后3min 内血压、心率基本复原。2例高血压患者延迟复原。3例检查前心肌慢性缺血者插镜后出现心绞痛而中止检查。胃粘膜活检时10例老年人心率瞬间变慢,其中1例窦性停搏。结论内镜检查时心脏并发症主要由交感-肾上腺系统紧张性增高使心脏负荷增加引起,少数由迷走反射引起,其并发症的严重程度取决于心脏本身的生理、病理状态。

AIMS To study the causes of cardiac complications during gastroscopy. METHODS Observations were made on the ECG and the BP of 115 pa- tients before,during and after gastroscopy. RESULTS BP elevated and heart-beat speed up at the beginning of gas- troscopy in all cases.In 110 cases these changes disappeared within three minutes after the end of gastroscopy(96%).However in two patients with hypertension,the recovery of the elevated BP was postponed. Three patients with chronic myocardial ischemia had a typical angina pectoris in the early phase of gastroscopy.In seven out of nine patients with sick sino-atrial node,the heart-beat slowed down during biopsy of gastric mucosa(77.8%).One of them had a transient sinus arrest. CONCLUClONS The sympathetico-adrenomedullary system may be excited in the early phase of gastroscopy which increased the burden of the heart.This may be the main reason for cardiac complications.However gastroscopy may also cause vagal reflex which may inhibit the heart of the patient with sick sino-atrial node during biopsy of gastric mucosa.