在进行重大血管重建手术之前，对患者的医疗管理的最佳程度如何？一项横断面研究的结果。
How optimal is the medical management of patients prior to major reconstructive vascular surgery? The results of a cross-sectional study.
作者信息
Marshall Christy, Lin Peter H, Huynh Tam T, Kougias Panagiotis
机构信息
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA.
出版信息
Vasc Endovascular Surg. 2009 Jun-Jul;43(3):238-43. doi: 10.1177/1538574408330399. Epub 2009 Feb 3.
BACKGROUND
Risk factor modification is important in patients with vascular disease. Guidelines suggest that this patient population benefits from a medical regimen of antiplatelets, statins, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.
MATERIALS AND METHODS
The medical regimen of consecutive patients who presented for major vascular surgery intervention over 18 months was examined.
RESULTS
Of the 325 patients identified, 176 (54%) were on antiplatelet treatment, 197 (61%) were on a statin, 180 (55%) on beta-blockers, and 146 (54%) on ACE inhibitors. A high-risk subset of 94 smokers with known coronary artery disease, hypertension, and hyperlipidemia or diabetes was identified. In this subset, patients were more likely to be on pharmacologic risk factor modification.
CONCLUSIONS
Despite recommendations, the pharmacologic risk factor modification of patients prior to vascular surgery remains suboptimal. Increased awareness of the problem and active participation of the vascular specialist are essential to improve compliance with established guidelines.
背景
对于血管疾病患者，改变危险因素至关重要。指南表明，这一患者群体可从抗血小板药物、他汀类药物、β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂的药物治疗方案中获益。
材料与方法
对18个月内接受重大血管手术干预的连续患者的药物治疗方案进行了检查。
结果
在确定的325例患者中，176例（54%）接受抗血小板治疗，197例（61%）服用他汀类药物，180例（55%）使用β受体阻滞剂，146例（54%）使用ACE抑制剂。确定了一个由94名患有已知冠状动脉疾病、高血压、高脂血症或糖尿病的吸烟者组成的高危亚组。在这个亚组中，患者更有可能接受药物危险因素调整。
结论
尽管有相关建议，但血管手术前患者的药物危险因素调整仍未达到最佳状态。提高对该问题的认识以及血管专科医生的积极参与对于提高对既定指南的依从性至关重要。
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