Kelly Rosemary F, McFalls Edward O
Division of Cardiology, VA Medical Center, University of Minnesota, 1 Veterans Drive, 111C, Minneapolis, MN 55414, USA.
Curr Treat Options Cardiovasc Med. 2006 Feb;8(1):59-66. doi: 10.1007/s11936-006-0026-6.
One of the most controversial topics in clinical cardiology is the extent of preoperative studies that is required among patients scheduled for major elective noncardiac operations. Patients in need of an elective operation for either an expanding aortic aneurysm or lower limb ischemia have the highest risk of postoperative cardiac complications because of the high prevalence of coronary artery disease and the hemodynamic stresses associated with the vascular procedures. The decision to perform preoperative coronary angiography should be reserved for only those patients who are deemed clinically unstable or are functionally limited by cardiac symptoms. Among patients with minimal symptoms, preoperative coronary artery revascularization with either coronary artery bypass graft surgery or percutaneous coronary interventions delays the needed operation and does not improve short-term outcomes or long-term survival.
临床心脏病学中最具争议的话题之一是，对于计划进行大型择期非心脏手术的患者，术前检查应进行到何种程度。因冠状动脉疾病的高患病率以及与血管手术相关的血流动力学压力，需要对扩张性主动脉瘤或下肢缺血进行择期手术的患者，术后发生心脏并发症的风险最高。术前冠状动脉造影的决定应仅保留给那些临床不稳定或因心脏症状而功能受限的患者。在症状轻微的患者中，通过冠状动脉搭桥手术或经皮冠状动脉介入治疗进行术前冠状动脉血运重建会延迟所需手术，并且不会改善短期预后或长期生存率。
