推衍12导联心电图对老年骨科患者术中心肌缺血监测的临床价值分析

Monitoring Myocardial Ischemia by EASI-derived 12-lead Electrocardiogram in Orthopedic Surgery of Geriatric Patients

目的探讨推衍12导联心电图ST段连续监测对老年骨科患者术中心肌缺血监测的临床价值。方法对95例老年骨科患者术中连续监测推衍心电图12导联ST段。结果被调查老年患者术中心肌缺血总的发生率为36.8%(35/95),其中全身麻醉43.5%(10/23),腰/硬麻醉40%(24/60)和神经阻滞麻醉8.3%(1/12)。未发生心肌缺血者合并高血压病的比例(21/60)明显低于发生心肌缺血者(26/35),差异有统计学意义(P<0.05)。术中发生的心肌缺血事件,70%(49/70)持续时间<5min;72.9%(51/70)ST段压低≤0.15mV。结论推衍12导联心电图可用于老年骨科术中心肌缺血的检测,高血压病为术中发生心肌缺血的易患因素,术中发生的心肌缺血绝大多数持续时间短、ST段压低程度轻。

Objective To investigate the clinical values of EASI-derived 12-lead Electrocardiogram （ECG） in continuously monitoring myocardial ischemia （MI） in elderly orthopaedic patients undergoing operation.Methods Ninety five aged patients with orthopedic operation were monitored continuously by EASI 12-lead ST-segment ECG. Results Among 95 geriatric patients,35 patients （36.8%） had myocardial ischemic events.43.5% （10/23）of the ischemic incidence was due to general anesthetics,40% （24/60）due to spinal or epidural anesthetics and 8.3%（1/12） due to nerve-block anesthetics.A history of hypertension was risk factors of intraoperative myocardial ischemia.Among the 70 ischemic events,the duration less than 5 minutes accounted for 70.0%（49/70）,ST-segment deviation of less than 0.15mv was 72.9%（51/70）. Conclusion During orthopaedic surgery in geriatric patients,EASI-derived 12-lead electrocardiogram is an optimal approach for monitoring myocardial ischemia.Underlying disease of hypertension is an important risk factor of intraoperative myocardial ischemia.Most intraoperative myocardial ischemia events have a short duration ,with a slight ST segment depression deviation.