Department of Anaesthesia, The Royal Melbourne Hospital, Melbourne, Vic., Australia.
Anaesthesia. 2012 Jul;67(7):714-20. doi: 10.1111/j.1365-2044.2012.07118.x. Epub 2012 Mar 27.
This prospective observational study investigated the effect of focused transthoracic echocardiography in 99 patients who had suspected cardiac disease or were ≥ 65 years old, and were scheduled for emergency non-cardiac surgery. The treating anaesthetist completed a diagnosis and management plan before and after transthoracic echocardiography, which was performed by an independent operator. Clinical examination rated cardiac disease present in 75%; the remainder were asymptomatic. The cardiac diagnosis was changed in 67% and the management plan in 44% of patients after echocardiography. Cardiac disease was identified by echocardiography in 64% of patients, which led to a step-up of treatment in 36% (4% delay for cardiology referral, 2% altered surgery, 4% intensive care and 26% intra-operative haemodynamic management changes). Absence of cardiac disease in 36% resulted in a step-down of treatment in 8% (no referral 3%, intensive care 1% or haemodynamic treatment 4%). Pre-operative focused transthoracic echocardiography in patients admitted for emergency surgery and with known cardiac disease or suspected to be at risk of cardiac disease frequently alters diagnosis and management.
这项前瞻性观察研究调查了 99 例疑似心脏病或年龄≥65 岁、拟行紧急非心脏手术的患者中，经胸超声心动图的效果。治疗麻醉师在经胸超声心动图前后完成了诊断和管理计划，该操作由独立操作者进行。临床检查评定 75%的患者有心脏病；其余为无症状。67%的患者经超声心动图后心脏诊断发生变化，44%的患者管理计划发生变化。超声心动图在 64%的患者中识别出了心脏病，这导致 36%的治疗升级（4%的延迟心内科转介，2%的手术改变，4%的重症监护和 26%的术中血流动力学管理改变）。36%的患者无心脏病，导致 8%的治疗降级（无转介 3%，重症监护 1%或血流动力学治疗 4%）。对于因紧急手术入院且已知有心脏病或疑似有心脏病风险的患者，术前进行集中经胸超声心动图检查通常会改变诊断和管理。
