在非心脏手术中进行心血管风险评估和管理:一篇评论
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
概括
在非心脏手术中进行手术前的心血管风险评估包括病史,体检和功能能力评估. 有针对性的检测和针对患者的医疗疗可以优化结果并减少外科心血管并发症.
科学领域:
- 心脏病学
- 麻醉学
- 血管外科
背景情况:
- 术前心血管并发症影响美国3%的非心脏手术住院.
- 有效的风险评估对于患者安全和优化手术结果至关重要.
研究的目的:
- 在非心脏手术前评估心血管风险的现有证据.
- 引导临床医生识别患有重大心血管不良事件 (MACE) 的患者.
主要方法:
- 对手术前心血管风险评估的文献综述.
- 对风险计算器,诊断测试和药物干预的分析.
主要成果:
- 专注的病史,体检和功能能力评估是关键.
- 风险计算器 (例如,修订的心脏风险指数) 将患者分为低 (< 1%) 和高 (≥ 1%) 的风险类别.
- 心血管检测很少适用于低风险患者;如果结果改变治疗方法,压力测试可能有利于选择高风险患者.
结论:
- 为定制外科手术治疗,必须对患者进行全面的评估.
- 不建议进行常规冠状动脉再血管,使用阿司匹林或高剂量的β- 阻断剂来降低外科手术期间的风险.
- 对于接受血管手术的动脉样性心血管疾病患者来说,他类药物可能是有益的.
- 由于风险增加,老年人 (≥75岁) 和冠状动脉支架患者需要仔细考虑手术前.
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