Perioperative myocardial infarction: a diagnostic dilemma.
Perioperative myocardial infarction: a diagnostic dilemma.
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围手术期心肌梗死：诊断困境。
DOI：
10.1016/s0003-4975(10)61277-5
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发表时间：
1980
期刊：
影响因子：
--
通讯作者：
S. Michalek
中科院分区：
文献类型：
--
作者：
S. Balderman;J. Bhayana;Jehuda J. Steinbach;A.R. Zaki Masud;S. Michalek
采用三种方法对冠状动脉旁路移植术患者围手术期心肌梗死(MI)的发生率进行了研究：连续心电图(ECG)、连续肌酸磷酸激酶同工酶(MB-CPK)和连续~(99m)Tc标记焦磷酸扫描。如果所研究的三个变量中的两个变量的结果为阳性，则明确的围手术期MI被诊断为MI。全组围手术期脑梗死率为8%。手术死亡率为2.9%。8例围手术期误诊中有7例仅用扫描诊断。同工酶结合心电分析诊断围手术期误诊5例。与心肌扫描相比，MB-CPK和心电图检查的假阳性诊断率更高。围手术期心肌梗死患者的临床病程为良性。对所有行主-冠脉搭桥术的患者进行三次常规99mTc-焦磷酸扫描的合理性仍有待确定。
Patients undergoing coronary bypass grafting were studied for incidence of perioperative myocardial infarction (MI) using three modalities: serial electrocardiograms (ECG), serial creatine phosphokinase isoenzymes (MB-CPK), and serial technetium 99m–labeled pyrophosphate scans. A definite perioperative MI was diagnosed if the results were positive in two of the three variables studied. The perioperative infarction rate for the entire group was 8%. The operative mortality was 2.9%. Seven of 8 perioperative MIs were diagnosed by the use of scanning alone. The combination of isoenzyme and ECG analysis diagnosed 5 of 8 perioperative MIs. The MB-CPK and ECG studies were associated with a higher incidence of false-positive diagnoses than myocardial scanning. Patients with perioperative MI had a benign clinical course. Justification for performing three routine99mTc-pyrophosphate scans on all patients undergoing aortocoronary bypass operation is still to be determined.