老年患者内镜逆行胰胆管造影术中心肌缺血的早期诊断和药物防治  

Early diagnosis, prevention and treatment of myocardial ischemia during endoscopic retrograde cholangiopancreatography in elderly patients

作　　者：方煊[1] 李雅丽[2] 陈新梅[3] 

机构地区：[1]浙江省绍兴第二医院普外科,312000 [2]新疆医科大学第一附属医院VIP内科,乌鲁木齐830054 [3]山东中医药大学药学院,济南250355

出　　处：《中华老年医学杂志》2016年第2期137-140,共4页Chinese Journal of Geriatrics

基　　金：国家自然科学基金（81460634）;山东中医药大学2013年“名科工程”青年骨干培养计划课题（ZYDXY1337）;新疆医科大学自然科学基金（2013ZRZD07）

摘　　要：目的探讨≥75岁患者逆行胰胆管造影术（ERCP）过程中发生心肌缺血的危险因素，早期诊断的生物标志物和处理措施，提高≥75岁患者ERCP术的有效性和安全性。方法将2013年1月到2014年12月本中心进行ERCP操作的患者82例，按年龄分为≥75岁组（42例）和％75岁组（40例），记录患者术前术中心电图检查结果、实验室血清学指标、ERCP操作参数以及并发症情况，对结果进行统计比较。结果≥75岁患者ASA分级增高、术中低温、术前感染黄疸、高血压均是ERCP术中心肌缺血事件的危险因素，生化指标髓过氧化物酶，肌酸激酶，心肌肌钙蛋白I能早期诊断无T波变化的心肌缺血患者。掌握麻醉适应证，连续监测及早预警，使用硝酸甘油，术中充分保温，吸氧能有效缓解ERCP操作过程中发生的心肌缺血。结论提前发现并有效缓解ERCP操作过程中发生的心肌缺血，能保障ERCP在≥75岁患者中安全有效的应用。Objective To investigate the risk factors and hiomarkers for early diagnosis and treatment for myocardial ischemia during endoscopic retrograde cholangiopancreatography （ERCP） in patients aged 975 years, in order to improve the effectiveness and security of ERCP. Methods A total of 82 patients undergoing ERCP in our hospital from Jan. 2013 to Dec. 2014 were divided into the elderly group （n = 42, aged≥75 years） and the non-elderly group （n = 40, aged 〈75 years）. The pre- and post-operative ECG findings, laboratory serological indexes, ERCP operating parameters and post-operative complications were compared between two groups. Results ASA grade was increased in elderly patients as compared with the non-elderly group. The intraoperative hypothermia, preoperative infection and jaundice, and hypertension were risk factors for myocardial ischemia during ERCP. The biochemical indexes including myeloperoxidase, creatine kinase and cardiac troponin 1 were the biomarkers for early diagnosis of myocardial ischemia in patients with non-specific changes of ST-T wave. The indications of anesthesia meeting operation, the consecutive and close anesthesia monitoring, application of nitroglycerin, thermal insulation during operation, oxygen inhalation can effectively relieve myocardial ischemia during ERCP and effectively treating myocardial ischemia during ERCP operation. Conclusions The early discovering ERCP can ensure the safe and effectiveness of in elderly patients aged ≥75 years.

关 键 词：心肌缺血 内镜逆行胰胆管造影 并发症 

分 类 号：R57[医药卫生—消化系统] R542.2[医药卫生—内科学]