老年心肌梗死患者非心脏手术围手术期心肌缺血及心脏事件的分析

Analysis of perioperative myocardial ischemia and cardiac events in old patients with myocardial infarction who underwent noncardiac surgery

目的 探讨老年心肌梗死 (MI)患者行非心脏手术治疗时围手术期心肌缺血及心脏事件发生的特点。方法 分析 35例老年MI患者非心脏手术的围手术期临床病例资料。结果 (1)术后 15例 (43% )发生心肌缺血 ,其中 12例 (80 % )发生在术后 1～ 3d ,11例 (6 7% )无临床表现。 (2 ) 6例术前不稳定性心绞痛患者及 4例MI距手术时间间隔<3个月患者发生术后心肌缺血 (P <0 .0 5 )。 (3)发生术后MI 1例 (3.0 % )。 (4)MI距手术时间间隔 <3个月的患者中 ,术后无再次MI及死亡发生。结论 老年心肌梗死患者行非心脏手术 ,术后早期易发生无症状心肌缺血 ,术后再次梗死的发生率较高。新近的心肌梗死并不是手术的绝对禁忌证。

Objective To investigate the characteristics of perioperative myocardial ischemia and cardiac events in old patients with MI who underwent noncardiac surgery.Methods The medical history of 35 old patients with MI who underwent noncardiac surgery was collected and analyzed.Results (1)Fifteen patients(43%) developed postoperative myocardial ischemia.Of them 12 cases developed it during the first 3 days and 11 cases were asymptomatic.(2) Six patients who had unstable angina pectoris before surgery and 4 cases who suffered from myocardial infarction in recent 3 months developed postoperative myocardial ischemia (P< 0.05). (3) One patient developed myocardial infarction again.(4)No reinfarction and death occurred in patients who suffered from myocardial infarction in recent 3 months.Conclusions Postoperative asymptomatic myocardial ischemia is relatively common in old patients with MI who underwent noncardiac surgery.It generally occurs during the first three days after surgery.The morbidity of reinfarction after surgery is relatively high.Recent myocardial infarction is not the absolute contraindication of surgery.