大型非心脏手术前的功能能力评估:国际前性队列研究
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
概括
对患者的功能能力进行主观评估对于重大手术风险是不可靠的. 杜克活动状态指数 (DASI) 是一个更好的手术前心脏风险评估工具.
科学领域:
- 心脏病学
- 麻醉学
- 老年医学
- 手术风险评估
背景情况:
- 功能能力对于评估重大手术风险至关重要.
- 功能能力的主观临床评估缺乏可靠的准确性.
- 需要客观标记来改善手术前的风险评估.
研究的目的:
- 将主观功能能力评估与预测外科结果的客观标志物进行比较.
- 评估心肺运动测试 (CPET),杜克活动状态指数 (DASI) 和NT-proBNP的风险分层.
- 确定最准确的手术前风险评估方法.
主要方法:
- 这是一项多中心的国际前性队列研究,对1401名年龄≥40岁的患者进行了重大非心脏手术.
- 对主观功能能力评估与CPET,DASI分数和NT-proBNP水平进行比较.
- 主要结局:使用逻辑回归和ROC曲线分析的30天死亡或心肌梗塞.
主要成果:
- 只有DASI得分有显著的预测主要结果 (30天内死亡或心肌梗塞).
- 主观评估显示在识别功能能力低下 (< 4 MET) 时的灵敏度低 (19. 2%).
- 2% 的患者出现了主要结局,突显了准确风险预测的必要性.
结论:
- 对于手术前风险评估而言,对功能能力的主观评估是不够的.
- 杜克活动状态指数 (DASI) 是手术前评估心脏风险的重要工具.
- 应考虑像DASI这样的客观措施来提高非心脏手术的主要患者的安全性.
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