推衍12导联心电图监测骨科术中心肌缺血的研究

目的应用推衍12导联心电图ST段连续监测得出骨科术中心肌缺血的发生规律。方法对311例骨科患者术中连续监测推衍12导联心电图sT段。结果患者术中心肌缺血总的发生率为26．0％（81／311），其中全身麻醉患者比局音口麻醉患者心肌缺血发生率高（38．1％比23．0％，P=0．015）。有71．6％（58／81）的患者发生心肌缺血时HR〉90次／min。术中发生的心肌缺血事件，79．7％（141／177）持续时间65min；71．2％（126／177）ST段压低60．15mV。结论推衍12导联心电图可用于骨科术中心肌缺血的监测，全身麻醉患者心肌缺血发生率较高，缺血事件大多数同心率增快有关，术中发生的心肌缺血绝大多数持续时间短、ST段压低程度轻。

Monitoring myocardial ischemia by EASI-derived 12-lead electrocardiogram in orthopaedic surgery

Objective To investigate possibility of monitoring myocardial ischemia by continuous EASI 12-lead ST- segment trend analysis during orthopaedic surgery and find its rules. Methods Three hundred and eleven consecutive patients who underwent orthopaedic surgery were monitored by continuous EASI 12＂lead ST- segment analysis during surgery. Results Among 311 patients 81 patients （26.0%） had myocardial ischemic events. The ischemic incidence of general anesthetics was significantly higher than local anesthetics （the spinal or epidural anesthetics and nerve-block anesthetics）（38.1% vs 23.0%, P = 0.015）. During ischemic events the patients whose heart rate exceeded 90 beat per minute was 71.6% （58/81）. Among the 177 ischemic events,the duration of less than 5 minutes was 79.7%（141/177）, ST-segment deviation of less than 0.15 mV was 71.2%（126/177）. Conclusions During orthopaedic surgery EASI 12-lead electrocardiogram is the optimal approach for monitoring myocardial ischemia.The ischemic incidence of general anesthetics is significantly higher than local anesthetics. The myocardial ischemia events correlates with fast heart rate. The intraoperative myocardial.ischemia events are more often transient. In most of these ischemic events ST- segment deviation is not very serious.