在选择性非心脏手术前的风险评估期间评估功能能力的临床工具:一个范围审查
Julian F Daza1, Tyler R Chesney2, Juan F Morales3
1Division of General Surgery, Department of Surgery, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (J.F.D.).
Annals of internal medicine
|November 11, 2024
概括
术前功能能力评估工具对于风险分层至关重要,但证据有限. 研究主要集中在心肺运动测试 (CPET),忽视了其他工具和脆弱的患者群体.
科学领域:
- 术前医学 术前医学
- 临床评估 临床评估
- 手术风险分层的分层化
背景情况:
- 功能能力对于术前风险评估至关重要.
- 目前的临床实践缺乏用于测量功能能力的标准化指导.
研究的目的:
- 识别和评估手术前使用的功能能力评估工具.
- 描述工具性能的证据基础,包括复杂的患者群体.
主要方法:
- 在2024年7月之前对MEDLINE,EMBASE和EBM审查进行系统审查.
- 包括的研究评估了在选择性非心脏外科手术中风险分层的功能能力工具.
主要成果:
- 确定了六个基于表现的功能能力评估类别和五个患者报告的功能能力评估类别.
- 心肺运动测试 (CPET) 和实地行走测试是最受研究的绩效指标.
- 还研究了患者报告的指标,如杜克活动状态指数和非结构化评估.
- 证据主要集中在预测有效性上,大多数工具的可靠性,实用性和临床实用性存在差距.
- 老年人代表性很好,但对肥胖,关节炎或残疾患者的数据很少.
结论:
- 虽然存在多种工具,但研究大力支持CPET和预测有效性.
- 对于特定患者子组的功能能力评估,仍然存在显著的证据差距.
- 需要进一步的研究来验证各种工具,并评估不同人群的临床效用.
相关概念视频
01:26Exercise Stress Test
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Introduction
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
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01:23Assessment of the Cardiovascular System I: Subjective Data
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A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
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...
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...
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