Romero L, de Virgilio C
Department of Surgery, Harbor UCLA Medical Center, 1000 W Carson St, Torrance, CA 90509, USA.
Arch Surg. 2001 Dec;136(12):1370-6. doi: 10.1001/archsurg.136.12.1370.
We provide an updated algorithm for approaching preoperative cardiac risk assessment in patients undergoing noncardiac surgery.
A National Library of Medicine PubMed literature search was performed dating back to 1985 using the keywords "preoperative cardiac risk for noncardiac surgery." This search was restricted to English language articles involving human subjects.
Patient-specific and operation-specific cardiac risk can be determined clinically. Patients with major cardiac risk factors have a high incidence of perioperative cardiac complications, whereas the risk is less than 3% for low-risk patients. For intermediate-risk patients, no prospective randomized studies demonstrate the efficacy of noninvasive stress testing (dipyridamole thallium or dobutamine echocardiography) or of subsequent coronary revascularization for preventing perioperative cardiac complications. Recent studies demonstrate that perioperative beta-blockade significantly reduces the adverse cardiac event rate in intermediate-risk patients.
Most patients with high cardiac risk should proceed with coronary angiography. Patients with low cardiac risk can proceed to surgery without noninvasive testing. For intermediate-risk patients, consideration may be given to further stress testing prior to surgery; however, in most patients, proceeding to surgery with perioperative beta-blockade is an acceptable alternative.
我们提供一种用于对接受非心脏手术患者进行术前心脏风险评估的更新算法。
利用关键词“非心脏手术的术前心脏风险”对美国国立医学图书馆的PubMed文献数据库进行检索，时间追溯至1985年。该检索仅限于涉及人类受试者的英文文章。
可通过临床方法确定特定患者和特定手术的心脏风险。具有主要心脏危险因素的患者围手术期心脏并发症发生率较高，而低风险患者的风险低于3%。对于中度风险患者，尚无前瞻性随机研究证明无创应激试验（双嘧达莫铊或多巴酚丁胺超声心动图）或随后的冠状动脉血运重建对预防围手术期心脏并发症的有效性。近期研究表明，围手术期使用β受体阻滞剂可显著降低中度风险患者的不良心脏事件发生率。
大多数高心脏风险患者应进行冠状动脉造影。低心脏风险患者可在不进行无创检查的情况下进行手术。对于中度风险患者，可考虑在手术前进一步进行应激试验；然而，对于大多数患者，在围手术期使用β受体阻滞剂后进行手术是一种可接受的选择。
