影响遵守手术前心脏检测建议的因素:一个队列研究
Alexandra Stroda1, Tanja Sulot, Sebastian Roth
1From the Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany (AS, TS, SR, RM, GLB), Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland (EM), Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (DI), Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland (WS), Department of Anaesthesiology and Peri-operative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH), Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen (MF), Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (BBS), Department of translational medicine, University of Ferrara, Ferrara, Italy (SS), Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Spain (PM), Department of Anaesthesiology and ICU, Ankara University Medical School, Ankara, Turkey (SCT), Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands (JvW), Department of Anaesthesiology, Hospital Beatriz Ângelo, Loures, Portugal (FL), Aretaieion University Hospital National and Kapodistrian University of Athens, Athens, Greece (KT), Department of Peri-operative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (AG), Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany (H-JG), Anaesthesia and Intensive Care Department, University Hospital, Varese, Italy (LG), Department of Anaesthesiology, Intensive Care and Pain Management, Pomeranian Medical University, Szczecin, Poland (KK), Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany (JL), Anaesthesia and Intensive Care Department III, Carol Davila University of Medicine and Pharmacy Bucharest, Central Military Emergency University Hospital 'Dr Carol Davila', Bucharest, Romania (DC), Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom (SJH), and CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Germany (GLB, AS, SR, RM).
对手术前压力成像指南的遵守率很高,但对胸前心声回声 (TTE) 的遵守率中等. 患者和地理因素影响了遵守欧洲心脏病学会 (ESC) 的心脏风险评估指南.
科学领域:
- 心脏病学 心脏病学
- 在外科手术期间的医学.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在非心脏手术之前对心脏风险进行评估,对于量身定制手术前管理至关重要.
- 了解遵守欧洲心脏病学会 (ESC) 对心血管风险的指导方针是有限的.
- 影响欧洲患者遵守指南的因素需要进一步探索.
研究的目的:
- 评估是否遵守2014年ESC/欧洲麻醉学会 (ESA) 关于手术前休息心声学 (TTE) 和压力成像的指南.
- 确定影响大型欧洲群体遵守这些指南的因素.
- 在术前心脏风险评估中分析TTE和压力成像的过度使用和过少使用.
主要方法:
- 对前性多中心MET-REPAIR队列研究的二次分析.
- 包括15529名心血管风险较高的患者在25个欧洲中心接受选择性非心脏手术 (2017-2020年).
- 多变量回归分析,以探索患者人口统计学 (性别,年龄) 和医院特征 (地理区域,教学状态) 对遵守的影响.
主要成果:
- 在手术前的TTE过度使用率为16.6%,不足使用率为6.6%.
- 压力成像过度使用为1.7%,使用不足为0.4%.
- 男性性别,某些年龄组和地理区域与TTE过度使用/使用不足和压力成像使用不足显著相关.
结论:
- 对手术前压力成像推的遵守率很高,而对TTE推的遵守率很低.
- 术前心脏风险评估指南的遵守受患者特异性因素和地理变异的影响.
- 这些发现突出了在临床实践中应用ESC/ESA指南方面需要改进的领域.
相关概念视频
Pre-Procedural Guidelines for Assessing Blood Pressure
Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.


