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  1. ホーム
  3. 研究分野
  5. 生物医学と臨床科学
  7. 心血管医学と血液学
  9. 心臓病 (心血管疾患を含む)
  11. 非心臓外科手術における手術後の心血管リスク評価と管理: レビュー
  1. ホーム
  3. 研究分野
  5. 生物医学と臨床科学
  7. 心血管医学と血液学
  9. 心臓病 (心血管疾患を含む)
  11. 非心臓外科手術における手術後の心血管リスク評価と管理: レビュー

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非心臓外科手術における手術後の心血管リスク評価と管理: レビュー

Nathaniel R Smilowitz1,2, Jeffrey S Berger1,3

  • 1Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.

JAMA
|July 22, 2020

PubMed で要約を見る

まとめ
この要約は機械生成です。

非心臓手術の術前心血管リスク評価には,病歴,身体検査,機能能力評価が含まれます. 標的を絞った検査と 患者に特化した医療療法により 治療結果を最適化し 術後の心血管合併症を減らすことができます

科学分野:

  • 心臓病科
  • 麻酔科
  • 血管 外科

背景:

  • 術後の心臓血管合併症は,米国における非心臓手術の入院の3%に起因する.
  • 効果的なリスク評価は 患者の安全と手術の結果の最適化に不可欠です

研究 の 目的:

  • 心臓外科手術前の心血管リスク評価に関する現在の証拠をレビューする.
  • 主要な心血管疾患 (MACE) のリスクのある患者を特定するために,臨床医を指導する.

主な方法:

  • 術前の心血管リスク評価に関する文献レビュー
  • リスク計算機,診断検査,薬理学的介入の分析

主要な成果:

  • 集中した歴史,身体検査,機能能力の評価は鍵です.
  • リスク計算機 (例えば,修正された心臓リスク指数) は,患者を低 (< 1%) と高 (≥ 1%) のリスクカテゴリーに分類します.
  • 心血管検査は低リスクの患者ではめったに推奨されないが,結果が管理に影響を及ぼす場合,ストレス検査は特定の高リスクの患者に有益である.

結論:

  • 患者を全面的に評価することは,手術後の治療の調整に不可欠です.

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ポリシー
  • 定期的な冠動脈再循環,アスピリン,または高用量のベータブロッカーは,外科手術後のリスクを減らすために推奨されません.
  • 静脈硬化性心血管疾患で血管外科手術を受ける患者には,スタチンは有益である.
  • 高齢者 (≥75歳) と冠動脈ステントを装着した患者は,リスクが増加したため,手術前には慎重に検討する必要があります.