陈旧性心肌梗死患者腹部手术围手术期处理

Perioperative management of patients with old myocardial infarction undergoing abdominal surgery

目的总结陈旧性心肌梗死患者腹部手术围手术期处理体会。方法对35例行腹部手术的陈旧性心肌梗死患者围手术期处理进行回顾性分析,胆囊切除9例,胆囊切除+胆管探查T管引流8例,肝部分切除1例;胃癌根治7例,直结肠癌根治7例,胃穿孔修补1例,十二指肠漏旷置1例,胰十二指肠切除1例。结果合并高血压22例(62.8%),心律失常14例(40%),糖尿病11例(31.4%),脑血栓6例(17.1%),完全右束支传导阻滞4例(11.4%),慢性支气管炎并肺气肿2例(5.7%),风湿性心瓣膜病并心力衰竭1例(2.9%)。术中出现血压剧烈波动10例,低血压5例。术后出现心律失常3例,心肌缺血4例,心力衰竭2例。治愈34例,再发心肌梗死死亡1例。结论陈旧性心肌梗死患者实施腹部手术时充分的术前准备非常必要,术中要防止低血压,术后要防止心肌缺血和心功能衰竭。

Objective To summarize the experience of perioperative management of patients with old myocardial infarction undergoing abdominal surgery. Methods Perioperative management of 35 cases with old myocardial infarction undergoing abdominal surgery was analyzed retrospectively. Of these patients, 9 underwent cholecystectomy, 8 cholecystectomy and open common bile duct exploration with T-tube drainage, 1 partial hepatectomy, 7 radical treatment of gastric cancer, 7 radical resection of colorectal cancers, 1 repair of stomach perforation, 1 external placement of duodenal leak and 1 pancreatico duodenal excision. Results Twenty-two cases suffered from myocardial infarction and hypertension, 14 had arrhythmia, 11 suffered from diabetes, 6 suffered from cerebral thrombosis, 4 had complete right bundle branch block, 2 had chronic bronchitis and emphysema, 1 suffered from rheumatic heart disease and heart failure. Ten cases had dramatic fluctuation of blood pressure during operation and 5 had hypotension. After operation, 3 had arrhythmia, 4 had myocardial isehemia, 2 had heart failure. Thirty-four cases were cured and only 1 case died of acute myocardial infarction. Conclusion When patients with old myocardial infarction undergoing abdominal surgery, sufficient preoperative preparation is very important. The hypotension should be prevented during operation and the prophylactic measures against myocardial isehemia and heart failure after operation are also required.