Sens N, Payan A, Sztark F, Piriou V, Bouaziz H, Bruder N, Jaber S, Jouffroy L, Lebuffe G, Mantz J, Piriou V, Roche S, Sztark F, Tauzin-Fin F
Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
Ann Fr Anesth Reanim. 2013 Oct;32(10):676-83. doi: 10.1016/j.annfar.2013.07.807. Epub 2013 Oct 2.
Professional practice evaluation of anaesthesiologist for high cardiac-risk patient cares in non-cardiac surgery, and assess disparities between results and recommendations.
Since June to September 2011, a self-questionnaire was sent to 5000 anesthesiologist. They were considered to be representative of national anesthesiology practitioner. Different items investigated concerned: demography, preoperative cardiac-risk assessment, modalities of specialized cardiologic advice, per- and postoperative care, and finally knowledge of current recommendations.
We collected 1255 questionnaire, that is to say 25% of answers. Men were 73%, 38% were employed by public hospital; 70% worked in a shared operating theatre with a general activity. With regards to preoperative assessment, 85% of anaesthetists referred high cardiac-risk patient to a cardiologist. In only 16% of answer, Lee's score appeared in anaesthesia file to assess perioperative cardiac-risk. Only 61% considered the six necessary items to optimal estimate of cardiac-risk. On the other hand, 91% measured routinely the exercise capacities by interrogation. The most frequently doing exam (49% of anaesthetist) was an electrocardiogram in elderly patient. In 96% of case, beta-blockers were given in premedication if they were usually thought. Clopidogrel was stopped by 62% of anesthetist before surgery. In this case, 38% used another medication to take over from this one. Only 7% considered revascularization in coronary patient who were effectively treated. POISE study was know by 40% of practitioner, and 18% estimated that they have changed their practice. Preoperatively, 21% organized multidisciplinary approach for high-risk patient. During surgery, 63% monitored the ST-segment. In postoperative period for cardiac-risk patient, only 11% prescribed systematically an ECG, a troponin dosage, a postoperative monitoring of ST-segment, a cardiologic advice. In case of moderate troponin elevation, they were 70% to realize at least an ECG and/or an echocardiography.
This study highlights some difference between current recommendation concerning assessment of cardiac-risk patient in non-cardiac surgery and daily practice of anesthetist, justifying regular update of this one.
对麻醉医生在非心脏手术中对高心脏风险患者的护理进行专业实践评估，并评估结果与建议之间的差异。
2011年6月至9月，向5000名麻醉医生发送了一份自填式问卷。他们被认为是全国麻醉学从业者的代表。调查的不同项目包括：人口统计学、术前心脏风险评估、专业心脏科建议的方式、围手术期和术后护理，以及对当前建议的了解。
我们收集了1255份问卷，即25%的回复率。男性占73%，38%受雇于公立医院；70%在具有一般业务的共享手术室工作。关于术前评估，85%的麻醉医生将高心脏风险患者转诊给心脏病专家。在仅16%的回复中，Lee评分出现在麻醉记录中以评估围手术期心脏风险。只有61%的人考虑了对心脏风险进行最佳评估所需的六个必要项目。另一方面，91%的人通过询问常规测量运动能力。最常进行的检查（49%的麻醉医生）是老年患者的心电图。在96%的病例中，如果通常认为有必要，术前会给予β受体阻滞剂。62%的麻醉医生在手术前停用氯吡格雷。在这种情况下，38%的人使用另一种药物来替代它。只有7%的人考虑对接受有效治疗的冠心病患者进行血运重建。40%的从业者知道POISE研究，18%的人估计他们已经改变了自己的做法。术前，21%的人针对高危患者组织了多学科方法。手术期间，63%的人监测ST段。在心脏风险患者的术后阶段，只有11%的人系统地开具心电图、肌钙蛋白检测、术后ST段监测、心脏科建议。在肌钙蛋白中度升高的情况下，70%的人至少会进行一次心电图和/或超声心动图检查。
本研究强调了当前关于非心脏手术中心脏风险患者评估的建议与麻醉医生日常实践之间的一些差异，证明有必要定期更新这些建议。
