心肌梗塞后患者进行非心脏手术的一些问题

本文分析了14例心肌梗塞(MI)后患者进行17次非心脏手术的临床情况.4次在MI后6个月内进行,有1例死亡.13次在MI6个月以后进行,无近期死亡.我们体会到:在MI后6个月内遇有危及生命的外科情况,如胃肠穿孔、肠梗阻等,即使冒一定风险,也应急症手术.有些疾病如胆石症急性发作、上消化道出血等,力争内科治疗缓解病情,于MI半年后择期手术.在MI急性期发现可切除的恶性肿瘤,若情况允许,以尽早施行手术为宜.高龄及心功能不全也为手术危险因素.心肌梗塞后患者必须进行较大的非心脏手术而又有冠脉供血不足时,可考虑先行冠脉旁路手术,再作非心脏手术.

Some problems of noncardiac operations on patients after myocardial infarction

The clinical courses of 14 patients with acute myocardial infarction undergoing 17 noncardiac operations were analysed. Among them,4 were performed wethin 6 months of the acute attack with one fatality,while the remaining 13 6 months after attack without mortality. It was reported in the literature that noncardiac operations performe -d within 6 months of acute myocardial infarction would entail much greater risk than those performed 6 months after the attack,so the operation should be considered according to different situations. Emerg-ency surgical conditio ns likely to jeopardize patient's life such as perforation of gastroenteral tract and intestinal obstruction should be operated right away if possible. Patients with acute attack of cholelithias is or gastrointestinal bleeding should be alleviated with conservative methods and then be operated 6 months after infarction. Malignant tumors diagnosed within 6 months of acute infarction should be operated as soon as possible to decrease the possibility of metastasis. A case with caroinoma of right colon diagnosed during the acute stage of a non Q-wave infarction was subjected first to coronary bypass surgery and one month later to right hemicolectomy successful -ly. It is also pointed out that advanced age and cardiac decompensation are two additional important risk factors for noncardiac operations after myocardial infarction.