非心脏手术患者围术期心肌梗死的特点及危险因素

Risk factors of perioperative myocardial infarction in the patients undergoing noncardiac surgery

目的研究非心脏手术患者围术期心肌梗死的高危因素及预后。方法选取562例非心脏手术患者,收集患者的围术期病例资料,统计患者心肌梗死危险因素,围术期心肌梗死的发生率及特点。结果在562例患者中共有19例发生围术期心肌梗死,发生率为3.4%,发生时间为术后(43.5±12.7)h。其中非ST段抬高心肌梗死11例,ST段抬高心肌梗死8例;左冠状动脉梗死14例,右冠状动脉梗死5例。年龄、既往有心肌梗死病史、术前有不稳定型心绞痛、术前心电图ST-T段改变、术前冠状动脉病变、术前糖尿病、术前高血压病、非心脏手术的级别均是围术期心肌梗死的高危因素,且与围术期心肌梗死的发生相关。19例心肌梗死的患者中,有16例行急诊经皮冠状动脉介入治疗,3例行药物保守治疗,处置后2例仍有不稳定型心绞痛,1年内出现心功能下降1级及1级以上的患者有2例,心律失常1例,未再发生心肌梗死病例,无死亡病例。结论多种因素会导致围术期心肌梗死的发生,加强术前评估,对存在高危因素的患者给予预防措施,一旦发生心肌梗死,及时处理,绝大部分患者预后尚可。

Objective To investigate the risk factors and prognosis of perioperative myocardial infarction in the patients undergoing noncardiac surgery. Methods Clinical data of 562 patients who had accepted non-cardiac surgery was collected and retrospectively analyzed. The risk factors,treatments and outcomes of all these patients were recorded and analyzed. Results A total of 19 out of the 562 patients had perioperative myocardial infarction（ PMI）. The incidence was 3. 4%. The mean occurrence time was（ 43. 5 ± 12. 7） h after operation. Eleven PMI patients（ 11/19） were non-ST-segment elevation myocardial infarction and eight patients（ 8/19） were ST-segment elevation myocardial infarction. Thirteen PMI patients were left coronary artery occlusion and six patients were right coronary artery occlusion. Advanced age,history of myocardial infarction,unstable angina,change of ST-T segment on electrocardiography（ ECG）,multivessel diseases,diabetes,hypertension,and high risk non-cardiac surgery were the risk factors of PMI and positively correlated to PMI. Sixteen PMI（ 16/19） patients accepted PCI treatment and three patients（ 3/19） accepted drug conservative treatment. Two patients had unstable angina attack after treatment and one patient had arrhythmia. The heart function in two patients decreased by one or more than one class within the follow up of 1 year. No patient had recurrent acute myocardial infarction or deceased during follow-up.Conclusions Many factors could lead to PMI. Making preoperative assessment,recognizing patients of high risks and dealing with patients who had PMI in time was necessary.