大規模な心臓外科手術前の機能能力の評価:国際的な前向きなコホート研究
Duminda N Wijeysundera1, Rupert M Pearse2, Mark A Shulman3
1Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Lancet (London, England)
|August 3, 2018
まとめ
患者の機能能力の主観的な評価は,大きな手術のリスクには信頼できない. デューク・アクティビティ・ステータス・インデックス (DASI) は 術前の心臓リスク評価の 優れたツールです
科学分野:
- 心臓病科
- 麻酔科
- 高齢者医療
- 手術 リスク 評価
背景:
- 大手手術のリスクの評価には 機能能力が不可欠です
- 機能能力の主観的な臨床評価は,信頼できる正確さがない.
- 手術前リスク評価を改善するには 客観的なマーカーが必要です
研究 の 目的:
- 手術の結果を予測するための客観的なマーカーと主観的な機能能力の評価を比較する.
- 心肺運動テスト (CPET),デューク活動状態指数 (DASI),NT-proBNPをリスク層別化のために評価する.
- 大手心臓外科手術における 手術前リスク評価の最も正確な方法を決定する.
主な方法:
- 40歳以上の大規模な心臓外科手術を受けた1401人の患者で実施された多センター国際前向きコホート研究.
- 主観的な機能能力評価とCPET,DASIスコア,NT-proBNPレベルとの比較
- 主なアウトカム: ロジスティック回帰とROC曲線を用いて分析された30日間の死亡または心筋梗塞.
主要な成果:
- DASIスコアのみが,主要なアウトカム (30日以内の死亡または心筋梗塞) を有意に予測した.
- 主観的な評価では,機能能力の低下 (< 4 MET) を特定する際の感度が低い (19. 2%) ことが示された.
- 患者の2%が主要なアウトカムを経験し,正確なリスク予測の必要性を強調しました.
結論:
- 機能能力の主観的な評価は,手術前のリスク評価には不十分です.
- デューク・アクティビティ・ステータス・インデックス (DASI) は,手術前の心臓リスクの評価に役立つツールです.
- DASIのような客観的な措置は,選択的な心臓外科手術における患者の安全性を高めるために検討されるべきである.
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