非心脏手术围手术期心肌缺血与心脏事件的相关因素

摘要

目的　明确与围手术期心肌缺血之相关因素及与手术后心脏事件发生的关系，以期提出预防措施，减少围手术期心脏事件的发生。　方法　观察102例老年患者围手术期有无心肌缺血及心脏事件发生。　结果　发生围手术期缺血有38例，86.8%表现为无症状心肌缺血，仅5例(13.2%)有症状。患有糖尿病、原发性高血压、心绞痛、有心衰病史的患者围手术期缺血发生明显增高。有糖尿病患者高3.5倍，有心衰者高5.4倍。有围手术期缺血的患者发生围手术期心脏并发症的比例明显增高(高11倍)。　结论　围手术期心肌缺血是围手术期心脏事件发生的预警指标；围手术期心肌缺血(包括心肌梗死)大部分为无症状心肌缺血；有心绞痛和心衰病史的患者围手术期心肌缺血的发生明显增高。%Objective To explore the factors related to perioperative myocardial ischemia and the relationship between perioperative myocardial ischemia and cardiac events． Methods From 1994 to 1995，perioperative myocardial ischemia and cardiac events were observed in 102 patients over 60． Results Perioperative myocardial ischemia in the majority（86.8％）of them presented silent myocardial ischemia．The perioperative myocardial ischemia incidence in the patients with the histories of diabetes mellitus，hypertention，angina and heart failure was much higher than that without those diseases．The patients with perioperative myocardial ischemia had more perioperative cardiac events． Conclusions （1）Perioperative myocardial ischemia is a good predictor for perioperative cardiac events．（2）Majority of patients with perioperative myocardial ischemia presented silent myocardial ischemia．（3）Perioperative myocardial ischemia is prone to occur in the patients with the histories of angina and heart failure．