急性心肌梗死康复期病人非心脏手术的麻醉处理  

The perioperative management of patients with recent myocardial infarction undergoing non-cardiac surgery

作　　者：庄小凤[1] 薛张纲[1] 蒋豪[1] 

机构地区：[1]上海医科大学附属中山医院麻醉科,200322

出　　处：《中华麻醉学杂志》2001年第3期143-145,共3页Chinese Journal of Anesthesiology

摘　　要：目的　评价急性心肌梗死后进行非心脏手术围手术期的麻醉处理。方法　普外科和普胸外科病人 12例 ,(6 7± 4)岁。心梗发生至手术间隔 72 175d。麻醉选择为硬膜外阻滞或复合全身麻醉 ,保留硬膜外导管术后镇痛。结果　病人均顺利度过手术期。术中心电图监测无缺血性ST T改变。术后病人镇痛效果良好。随访至出院 ,无一例出现急性心衰和心肌梗死。结论　急性心肌梗死康复期病人进行非心脏手术应放宽时间限制。急性心梗康复期病人进行非心脏手术的危险不仅与心梗发生的时间间隔相关 ,还取决于冠心病的严重程度、病人对体力活动的耐受程度及外科手术性质。充分的术前准备对稳定围手术期心脏功能十分重要。Objective The purpose of this study was to evaluate the perioperative management of patients with recent myocardial infarction (MI) undergoing non-cardiac surgery.Methods Twelve patients underwent general or thoracic surgery on the 72th to 175th day after acute MI. Their mean age was (67±4 ) years old. All patients received epidural block or epidural block combined with general anesthesia. Epidural catheter was left in place for postoperative analgesia.Results All patients underwent operation smoothly. During operation ECG monitoring showed no ischemic ST-T changes. Postoperative pain relif was satisfactory. No acute heart failure or myocardial reinfarction occurred during their stay in hospital.Conclusions In patients who had recent MI the time interval between the first MI and surgery should not be the only factor in the risk assessment. Other factors such as urgency of surgery, the severity of coronary artery disease, exercise tolerance and complexity of surgery should also be considered. Adequate preoperative evaluation and preparation and maintenance of cardiac function during perioperative period are crucial to the safety of surgery. Epidural block combined with general anesthesia is the anesthesia of choice for patient with recent MI undergoing non-cardiac surgery.

关 键 词：急性心肌梗死 康复期 非心脏手术 麻醉 硬膜外麻醉 

分 类 号：R614[医药卫生—麻醉学]