一项针对台湾地区接受非心脏手术的心脏疾病患者心脏事件及围手术期管理的双中心调查。

A two-center survey of cardiac events and peri-operative managements of cardiac patients undergoing non-cardiac surgery in Taiwanese population.

作者信息

Poon Kin-Shing, Lee Ming-Chien, Yang Min-Wen, Chang Wen-Kuei, Chen Chia-Chen, Wu King-Chuen, Wu Rick Sai-Chuen

机构信息

Department of Anesthesiology, Pain Service & Critical Care Medicine, China Medical College Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, R.O.C.

出版信息

Acta Anaesthesiol Sin. 2003 Dec;41(4):173-8.

PMID:14768514

Abstract

BACKGROUND

The risk of cardiac patients undergoing noncardiac surgery is relatively high. Successful preoperative evaluation and perioperative anesthetic management of a patient require a good communication among the patient, the anesthesiologist and the surgeon as well as excellent cooperation between the surgeon and anesthesiologist with a tacit understanding of the peri-operative risks. Peri-operative risk factors have been readily investigated in Caucasians or Westerners. As different ethnic populations may have different risk factors for a same disease entity, understanding the uniqueness in this respect in Taiwanese is mandatory. The purpose of this study is to examine the risk factors, perioperative cardiac events and the qualities of preoperative preparation and post-operative intensive care in Taiwanese cardiac patients undergoing noncardiac surgery.

METHODS

Two medical centers in Taiwan worked out a set of prospective questionnaire to evaluate the preoperative preparation, intraoperative events, and postoperative care of cardiac patients undergoing noncardiac surgery in these hospitals.

RESULTS

Between March 2002 and May 2002, there were 196 cardiac patients undergoing noncardiac surgery out of a total of 10,129 anesthetized surgical patients in two medical centers. The risk factors of these patients included coronary artery disease, hypertension, diabetes mellitus, congestive heart failure, arrhythmia, and renal function impairment. In these 196 cases, only 26.5% (52) and 16.8% (33) had been preoperatively evaluated by cardiologist and anesthesiologist respectively through consultation. The number of pre-operation specific cardiac tests totaled 34, and 41 patients (20.9%) required post-operative intensive care. There were two peri-operative fatalities and fourteen peri-operative cardiac events.

CONCLUSIONS

The quality of care for preoperative evaluation and quality assurance need to be improved in Taiwan.

摘要

背景

接受非心脏手术的心脏病患者风险相对较高。患者、麻醉医生和外科医生之间良好的沟通以及外科医生与麻醉医生之间的出色合作，并对围手术期风险有默契的理解，对于患者术前评估的成功及围手术期麻醉管理至关重要。围手术期风险因素在高加索人或西方人中已得到充分研究。由于不同种族人群对于同一疾病实体可能存在不同的风险因素，因此了解台湾地区人群在这方面的独特性是必要的。本研究旨在探讨台湾地区接受非心脏手术的心脏病患者的风险因素、围手术期心脏事件以及术前准备和术后重症监护的质量。

方法

台湾的两家医疗中心制定了一套前瞻性问卷，以评估这些医院中接受非心脏手术的心脏病患者的术前准备、术中情况及术后护理。

结果

在2002年3月至2002年5月期间，两家医疗中心共有10129例接受麻醉的手术患者，其中196例为接受非心脏手术的心脏病患者。这些患者的风险因素包括冠状动脉疾病、高血压、糖尿病、充血性心力衰竭、心律失常及肾功能损害。在这196例患者中，分别只有26.5%（52例）和16.8%（33例）在术前经心脏病专家和麻醉医生会诊评估。术前特定心脏检查总数为34项，41例患者（20.9%）需要术后重症监护。围手术期有2例死亡及14例心脏事件。