陈旧性心肌梗死对冠心病患者非心脏手术围手术期心脏事件的影响

Influence of Prior Myocardial Infarction on Perioperative Cardiac Events in Patients Undergoing Noncardiac Surgery

目的 :探讨陈旧性心肌梗死对冠心病患者非心脏手术围手术期心脏事件的影响。方法 :1988年至 1997年连续收住我院的 45岁至 99岁大中型非心脏手术冠心病患者 12 5 9例 ,分为陈旧性心肌梗死组 (n =76)和非陈旧性心肌梗死组 (n =1183 ) ,对比分析手术类型、内科主要疾病史、术中术后主要心血管并发症等。结果 :两组手术类型和麻醉方式及心血管疾病史无显著性差异 ;与非陈旧性心肌梗死组相比 ,陈旧性心肌梗死组术前心功能不全、左心室射血分数≤ 0 5 0、肾功能不全和有心绞痛症状者多 ,心电图有缺血改变者少 ,两者比较有显著性差异 (P <0 0 5～ 0 0 1)。术中两组心血管并发症发生率无显著性差异。控制年龄和性别后与非陈旧性心肌梗死组相比 ,陈旧性心肌梗死组术后心肌梗死和心源性肺水肿的比数比 (OddsRatio ,OR)及 95 %可信区间分别是 19 3(5 6～ 66 2 ) ,5 7(2 5～ 12 9)。结论 :陈旧性心肌梗死患者非心脏手术术前心肾功能不全者多 ,有心绞痛症状者多 ,围手术期心脏事件发生率高且重。

Objective: To evaluate the influence of prior myocardial infarction (MI) on perioperative cardiac events in patients undergoing noncardiac surgery. Methods:One thousand two hundred fifty nine consecutive patients with coronary artery disease who underwent major noncardiac procedures between January 1988 and December 1997 were included. The patients were divided into two groups depending on presence or absence of prior MI. The types and nature of surgery, clinical history and perioperative cardiac complications were analyzed. Results: There was no significant statistic difference between groups in types and nature of surgery, clinical history of cardiovascular diseases.Among the patients prior MI were associated with a higher rate of cardiac dysfunction, lower left ventricular ejection fraction and renal insufficiency compared with the patients without prior MI.After controlling for age and sex,patients with prior MI had an increased odds ratio for postoperative MI and cardiogenic pulmonary edema 〔OR,19 3(95%CI 5 6 to 66 2);OR,5 7(95%CI 2 5 to 12 9)〕compared with patients without prior MI. Conclusion: Patients with prior MI who have undergone noncardiac surgery have a higher rate of major postoperative cardiac complications.