Comparison of hemodynamic, electrocardiographic, mechanical, and metabolic indicators of intraoperative myocardial ischemia in vascular surgical patients with coronary artery disease.
Comparison of hemodynamic, electrocardiographic, mechanical, and metabolic indicators of intraoperative myocardial ischemia in vascular surgical patients with coronary artery disease.
复制标题
冠状动脉疾病血管外科患者术中心肌缺血的血流动力学、心电图、机械和代谢指标的比较。
DOI：
10.1097/00000542-198901000-00006
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发表时间：
1989
期刊：
影响因子：
8.8
通讯作者：
Reiz,S
中科院分区：
文献类型：
--
作者：
Häggmark,S;Hohner,P;Ostman,M;Friedman,A;Diamond,G;Lowenstein,E;Reiz,S
方法.研究I.在麻醉和手术开始期间研究了患有冠状动脉疾病的麻醉血管手术患者：测量ECG、血流动力学、机械和代谢参数，并参照心肌缺血的特定定义将其分类为阳性或阴性。研究二.无缺血性心脏病的清醒患者分级起搏，并进行VCG ST分析。研究了麻醉猪与受控HR水平和短暂冠状动脉闭塞相关的局部代谢和VCG ST变化。研究IV. 35例麻醉的冠状动脉疾病（CAD）患者和10例非CAD患者在受控水平起搏，并使用大冠状动脉静脉（GCV）乳酸测量来确定是否存在心肌缺血。CAD患者起搏至可证实心肌缺血的HR水平。分析了HR相关VCG ST水平与是否存在缺血的关系。在研究II、III和IV中，分析了每个步骤的ST向量幅度（ST-VM）、ST-VM较基线的变化（STC-VM）和向量角度较基线的变化（STC-VA）。研究I.血流动力学、ECG、机械和代谢检测方法之间的阳性事件（推定心肌缺血）一致性较差。研究二. STC-VM，而不是ST-VM水平表明HR相关的增加，假定没有心肌缺血在18个清醒的受试者。J点时间ST测量不影响响应的VCG ST HR。研究III。STC-VM水平显示在不存在缺血的情况下HR相关增加（通过局部代谢观察进行测试）。VCG ST参数对短暂性局部缺血反应积极。研究IV.冠心病患者在起搏过程中表现出明确的缺血发作和进展模式，进一步分析了VCG ST水平与缺血的关系。STC-VM水平的敏感性和特异性通过针对一系列STC-VM水平的ROC分析来描述。
Methods. Study I. Anesthetised vascular surgical patients with coronary artery disease were studied during the start of anesthesia and surgery: ECG, hemodynamic, mechanical, and metabolic parameters were measured and categorised as positive or negative with reference to a specific definition of myocardial ischemia. Study II. Awake patients with no ischemic heart disease were paced in graded steps, and VCG ST analyses were performed.Study III. Anesthetised pigs were studied for local metabolic and VCG ST changes related to controlled HR levels and transient coronary occlusion. Study IV. Thirty five anesthetised coronary artery disease (CAD) patients and ten non-CAD patients were paced at controlled levels, and great coronary artery vein (GCV) lactate measurement was used to determine presence or absence of myocardial ischemia. The CAD patients were paced up to HR levels where myocardial ischemia could be confirmed. The relation of HR-related VCG ST levels to presence or absence of ischemia was analysed. In Studies II,, III, and IV the ST vector magnitude (ST-VM), the change from baseline in ST-VM (STC-VM), and the vector angle change from baseline (STC-VA) were analysed for each step.Results. Study I. Poor concordance was demonstrated for positive events (presumed myocardial ischemia) between the hemodynamic, ECG, mechanical, and metabolic detection methods. Study II. STC-VM but not ST-VM levels demonstrated HR-related increases in the presumed absence of myocardial ischemia in 18 awake subjects. J point time to ST measurement did not affect the response of VCG ST to HR. Study III. STC-VM levels showed HR-related increases in the absence of ischemia (tested by local metabolic observations). VCG ST parameters responded positively to transient regional ischemia. Study IV. CAD patients, which demonstrated a clear pattern of onset and progress of ischemia during pacing, were further analysed for the relation of VCG ST level to ischemia. Sensitivity and specificity of STC-VM levels were described by ROC analysis for a range of STC-VM levels.