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近年来,日本缺血性心脏疾患的发生率不断增加,随着高龄患者外科手术的积极开展,术后合并心肌梗塞(PMI)的可能性也逐渐增高。由于PMI约60%以上发生在手术后3日以内,此时因切口疼痛以及麻醉的影响,症状难以发现,故诊断多根据心律失常的出现和血液动力学状况的恶化而作出,常导致治疗被动和预后不良的后果。因此,对PMI防患于未然极为重要。本文简述合并缺血性心脏疾患病例的术前诊断及其对策。问诊:心肌梗塞(MI)病例约占半数发作前并无心绞痛。因此,既往有MI病史或因心绞痛正在服药者自不待说,即使对无胸前部压迫感等典型症状者也必须加以注意。应详细询问有无颈部,心窝部不适感以及上肢麻木等症状,详细了解这些症状发生的情况、持续时间以及频率等。
In recent years, the incidence of ischemic heart disease in Japan is on the rise. With the active operation of elderly patients, the possibility of postoperative myocardial infarction (PMI) gradually increases. As more than 60% of PMI occurred within 3 days after surgery, this time because of incisional pain and anesthesia, the symptoms difficult to find, so the diagnosis of arrhythmia and more based on the emergence of hemodynamic deterioration and often lead to passive treatment And the consequences of poor prognosis. Therefore, it is extremely important to take precautionary measures against PMI. This article describes the preoperative diagnosis of ischemic heart disease cases and its countermeasures. Interview: Myocardial infarction (MI) accounts for about half of the episodes before angina pectoris. Therefore, the history of MI or history of angina pectoris is not to be said, even if the typical symptoms such as a sense of pressure without a chest should also be noted. Should be asked in detail with or without neck, chest discomfort and upper limb numbness and other symptoms, a detailed understanding of the occurrence of these symptoms, duration and frequency.