老年冠心病非心脏手术患者围手术期心肌梗死的特点及危险因素

Characteristics and risk factors of perioperative myocardial infarction in the elderly patients with coronary artery disease undergoing noncardiac surgery

目的研究老年冠心病非心脏手术患者围手术期心肌梗死发生的特点、规律及危险因素。方法选择412例连续的老年冠心病非心脏手术患者的病例资料,用统一的表格对术前、术中和术后的相关数据进行记录,并通过χ2检验的方法得出围手术期心肌梗死发生的危险因素。结果在412例患者中共有10例发生围手术期急性心肌梗死,发生率为2.4%,均在术后发生。其中60%为非Q波心肌梗死,70%发生在术后7d内,仅30%表现为心绞痛。术前不稳定性心绞痛、心功能不全、ST段压低≥0.05mV及术后心肌缺血与围手术期心肌梗死的发生有关。结论老年冠心病非心脏手术患者围手术期心肌梗死大部分发生在术后1周内,多为无症状性和非Q波性心肌梗死。术前心功能不全、不稳定性心绞痛、ST段压低≥0.05mV及术后心肌缺血可能与围手术期心肌梗死的发生有关。

Objective To investigate the risk factors and characteristics of perioperative myocardial infarction in the elderly patients with coronary artery disease who underwent noncardiac surgery. Methods The consecutive clinical medical records of 412 elderly patients with coronary artery disease who underwent noncardiac surgery were selected . Some related preoperative, intraoperative and postoperative parameters of the patients were registered. The risk factors were obtained by χ^2 test. Results Ten of the 412 patients（2.43%） had postoperative myocardial infarction, 70% of which occurred within the first week after surgery. Only 3 of 10 had angina pectoris, 60% of them had non-Q wave myocardial infarction. Preoperative unstable angina pectoris, cardiac insufficiency, ST segment depression ≥ 0.05mV and postoperative myocardial ischemia were related to periopeartive myocardial infarction. Conclusion Most of the perioperative myocardial infarction was asymptomatic and non-Q wave type, and happened during the first week after surgery in the elderly patients with CHD. Preoperative unstable angina pectoris,cardiac insufficiency,ST segment depression ≥0.05mV and postoperative myocardial ischemia were related to periopeartive myocardial infarction.