高龄患者手术后并发心肌梗塞的特殊临床表现  

The special clinical manifestation of elderly patients with postoperative acute myocardial infarction

作　　者：朱立新[1] 王一农[1] 游玉贞 万钧 陈影波 范上达 汪恭恕[1] 张辉 罗晓明 雷勇 余昌俊[1] 赵天力 

机构地区：[1]香港大学玛丽医院外科,北京协和医院外科,安徽医科大学附属医院外科

出　　处：《普外临床》1997年第2期105-106,共2页

摘　　要：作者从１９９０年至１９９４年共为２６０例６０岁以上高龄患者施行手术，其中１８例并发心肌梗塞，全部为男性，术前多已合并有其他内科疾病，其中１３例合并慢性肺部疾病，占心肌梗塞病例总数的７２％，且此１３例患者均有十年以上吸烟史。吸烟者并发术后心肌梗塞机率明显高于非吸烟者。无痛型心肌梗塞发生率为２２％，不典型症状发生率为７７％。术后常规心电监护有助于早期诊断及提高治愈率。另有６例患者术后出现严重心肌缺氧，但术后二天内其ＥＣＧ及血清心肌酶却呈现类似心肌梗塞改变，经动态观察ＥＣＧ及心肌酶变化以后确诊，并均痊愈出院。但并发心肌梗塞的患者预后不佳，住院死亡率为３７％，主要死因为呼吸衰竭。Abstract:Two hundred and sixty patients over 60 years of age underwent operations in our department during 1990 and 1994. Acute myocardial infarction (AMI) occurred in 18 patients after operation. All the 18 cases of AMI were males who had many concomitant medical diseases before operation. Among the AMI cases, there were 13 (72% ) patients with concomitant chronic obstructive pulmonary diseases (COPD) before operations. All the 13 patients had smoking history more than 10 years. The morbidity of postoperative AMI in patients with smoking was significantly higher than in those without smoking history. The incidence of painless and untypical symptom in patients with AMI were 22% and 77% respectively. The prognosis in patients with postoperative AMI was poor and the hospital mortality rate was 37%. The main cause of death was respiratory failure. It will be helpful to detect the onset of AMI early and to reduce the mortality if the postoperative cardiac monitoring is available. There were 6 other patients whose changes in electrocardiogram (ECG) and elevation of myocardial enzymes simulated AMI during the first two days after operation. Their final diagnosis was myocardial ischemia as sequential tests on EGC and myocardial enzymes reversed to normal and their hospital mortality was zero.

关 键 词：心肌梗塞 肺疾病 吸烟 手术后 并发症 

分 类 号：R619[医药卫生—外科学] R542.22[医药卫生—临床医学]