颅脑手术后合并急性心肌梗死4例的临床分析

目的探讨颅脑手术后发生急性心肌梗死的特点及诊治措施。方法对我院2010年1-11月期间颅脑手术后发生急性心肌梗死的病例资料进行全面回顾性分析。结果 1 991例择期开颅手术,术后合并急性心肌梗死4例,1例气管插管未拔除,3例主诉心前区疼痛,术后24h内均出现血清酶学及心电图动态变化,CK、CK-MB及TnT均持续增高,峰值分别达1 800U/L、72ng/ml及2.15ng/ml。2例出现休克,1例出现心律失常及急性左心衰,1例在口服抗血小板药物治疗后出现硬膜外血肿。2例死亡,2例痊愈。结论颅脑手术可诱发急性心肌梗死的发生,术中低血压、应用止血药、疼痛、紧张、基础疾病等均可为诱因;急性脑血管意外也可引起心电图的异常变化和干扰并发急性心梗的及时诊断;加强术前评估、术后监测、早期诊断、合理应用抗凝及抗血小板治疗可降低颅脑手术后合并急性心梗的死亡率及颅内再出血率。

Acute myocardial infarction in patients after craniotomy:A report of 4 cases

Objective To study the clinical features of acute myocardial infarction(AMI) after craniotomy and its diagnosis and treatment.Methods Clinical data about 1991 patients who developed AMI after craniotomy in our hospital from January 2010 to November 2010 were retrospectively analyzed.Results Of the 1991 patients after operation,4 had AMI,1 had the tracheal intubation not removed,3 had precordial pain,2 had shock,1 had arrhythmia and acute left heart failure,2 died,and 2 recovered.Their CK,CK-MB and TnT level...