Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.
Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.
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DOI：
10.1097/00132586-198608000-00037
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发表时间：
1985-11
期刊：
影响因子：
37.8
通讯作者：
John S. Smith;M. Cahalan;D. Benefiel;B. Byrd;F. W. Lurz;W. Shapiro;M. Roizen;A. Bouchard;and;N. Schiller
中科院分区：
文献类型：
--
作者：
John S. Smith;M. Cahalan;D. Benefiel;B. Byrd;F. W. Lurz;W. Shapiro;M. Roizen;A. Bouchard;and;N. Schiller
由于左心室急性节段性室壁运动异常（SWMA）是心肌缺血的高度敏感和特异性指标，因此本研究比较了心肌缺血高危患者在麻醉和手术期间通过二维经食管超声心动图和体表心电图检测的缺血发生率和意义。在手术过程中，研究的50名患者中有24名有新的SWMA，而只有6名有ST段改变。所有ST段改变的患者也有新的SWMA：在3例中，SWMA发生在ST段改变之前，在3例中，它们同时发生。所有3例术中心肌梗死患者也有持续性术中SWMA，而只有1例患者有ST段改变。10例需要非心血管手术的健康患者进行了类似的监测;这些患者均无SWMA、ST段改变或心肌梗死。本研究证实了二维经食管超声心动图在术中检测心肌缺血方面优于心电图。此外，当新的SWMA持续到手术结束时，可能已经发生心肌梗死。
Because acute segmental wall motion abnormalities (SWMAs) of the left ventricle are highly sensitive and specific indicators of myocardial ischemia, this study compared the incidence and significance of ischemia, as detected by two-dimensional transesophageal echocardiography and surface electrocardiography, during anesthesia and surgery in patients at high risk of myocardial ischemia. During surgery, 24 of the 50 patients studied had new SWMAs, whereas only six had ST segment changes. All patients with ST segment changes also had new SWMAs: in three instances, SWMAs occurred before the ST segment change, and in three instances, they occurred simultaneously. All three patients who had intraoperative myocardial infarctions also had persistent intraoperative SWMAs, whereas only one patient had ST segment changes. Ten healthy patients requiring noncardiovascular surgery were monitored similarly; none of these had SWMAs, ST segment changes, or myocardial infarction. This study demonstrates the superiority of two-dimensional transesophageal echocardiography over electrocardiography for the intraoperative detection of myocardial ischemia. Furthermore, when new SWMAs persist to the conclusion of surgery, myocardial infarction is likely to have occurred.