高龄隐匿性冠心病患者围术期心血管功能异常研究

目的：探讨隐匿性冠心病（或无症状心肌缺血SMI）患者围术期的心血管功能异常及与年龄的相关性，探讨围术期心律失常的临床治疗和转归。方法：180例择期手术的无症状心肌缺血患者，年龄≥51岁者130例，按年龄将其分为51～60岁组、61～70岁组和71～80岁组，其余50例年龄≤50岁者为对照组。动态心电图连续记录患术前24h、术后24h、术后48h心电图信息，专业医师分析统计s11段下移及弓背样抬高的幅度、时间，各型心律失常、各时间段心律失常发生率等，同时记录临床治疗、效果及转归。结果：随年龄增加，ST段改变幅度及持续时间增大（P〈0．05，P〈0．01）；71～80岁组ST段弓背样抬高发生率大于对照组（P〈0．05）；61～70岁组ST段下移时间、71～80岁组ST段下移时间及弓背样抬高幅度大于51～60岁组（P〈0．05）。61～70岁组的加速性室性自主心率（A巩）发生率和71。80岁组的窦性的心动过缓（SB）、室性早搏（VPB）、室性心动过速（vT）发生率大于对照组（P〈0．05，P〈0．01）；61～70岁组的房颤（AF）发生率和71～80岁组的VP、VT及AF发生率大于51-60岁组（P〈0．05，P〈0．01）。各组术后24h心律失常发生率大于术后48h及术前24h（P〈0．01）；随年龄增加，排除诱因后可逆转的心律失常明显减少，需药物逆转和电学逆转者明显增加（P〈0．05）。结论：高龄SMI患者围术期心肌缺血及心律失常高发，且随着年龄的增加而增加，术后24h是心功能异常高发时段。

Perioperative cardiovascular abnormality in elder patients with silent coronary heart disease

Objective： To explore the perioperative cardiovascular dysfunction and its relevance to age in patients with silent coronary heart disease（or silent myocardial ischemia）, and explore the clinical treatment and recovery of perioperative arrhythmias. Methods： One hundred and eighty cases were selected from selective surgery patients with silent myocardial isehemia（SMI）. Among the cases, 130 patients older than 51 years old were divided into 51- 60 year-old group, 61 - 70 year-old group and 71 - 80 year-old group. Control group was set up by other 50 patients younger than 51 years old. Electrocardiogram data of 24 h before the operation, 24 h after the operation and 48 h after the operation were continuously monitored by dynamic electroeardiogram（DCG）. The electrocardiogram data of ST shifting, arrhythmia incidences of different type and at different time were analyzed by professional doctors. At the same time, the treatment and recovery of perioperative ar rhythmia were recorded. Results： As the age increase, the magnitude and duration of ST shifting appeared upward trend compared to the con trol group（ P 〈 0.05, P 〈 0.01）. The incidence of ST elevation in 71 - 80 year-old group was higher than the control group（ P 〈 0.05）. The ST depression duration in 61 - 70 and 71 - 80 year-old group and ST elevation magnitude in 71 - 80 year-old group were higher than 51 - 60 year-old group（ P 〈 0.05）. Compared to the control group, the incidence of accelerated idioventricular rhythm（AIR） in 61 - 70 year-old group and the incidence of sinus bradycardia（SB）, ventricular premature beat （VPB）, ventricular tachycardia（VT） in 71 - 80 year-old group were higher （ P 〈 0.05, P 〈 0.01 ）. Compared to the 51 - 60 year-old group, the incidence of atrial fibrillation（AF） in 61 - 70 year-old group and the incidence of VP, VT, AF in 71 - 80 year-old group were higher （ P 〈 0.05, P 〈 0.01）. The arrhythmia incidences in 24 h after op eration were higher than 48 h after operation and 24 h before operation（ P 〈0.01）. As the age increase, the recovery incidence by removing inducement was decreased, but the recovery incidences by drug and electric-shock treatment were increased（ P 〈 0.05）. Conduslon： Old SMI patients have high levels of perioperative myocardial ischemia and antaythmia, and 24 h after operation is the period of high incidence.