Fox Daniel L, Stream Amanda R, Bull Todd
University of Colorado, Aurora, CO, USA
University of Colorado Health Sciences Center, Aurora, CO, USA.
Semin Cardiothorac Vasc Anesth. 2014 Dec;18(4):310-8. doi: 10.1177/1089253214534780. Epub 2014 May 13.
Patients with pulmonary hypertension are at increased risk for perioperative morbidity and mortality. Elective surgery is generally discouraged in this patient population; however, there are times when surgery is deemed necessary. Currently, there are no guidelines for the preoperative risk assessment or perioperative management of subjects with pulmonary hypertension. The majority of the literature evaluating perioperative risk factors and mortality rates is observational and includes subjects with multiple etiologies of pulmonary hypertension. Subjects with pulmonary arterial hypertension, also referred to as World Health Organization group I pulmonary hypertension, and particularly those receiving pulmonary arterial hypertension-specific therapy may be at increased risk. Perioperative management of these patients requires a solid understanding and careful consideration of the hemodynamic effects of anesthetic agents, positive pressure ventilation and volume shifts associated with surgery in order to prevent acute right ventricular failure. We reviewed the most recent data regarding perioperative morbidity and mortality for subjects with pulmonary hypertension in an effort to better guide preoperative risk assessment and perioperative management by a multidisciplinary team.
肺动脉高压患者围手术期发病和死亡风险增加。一般不鼓励该患者群体进行择期手术；然而，有时手术被认为是必要的。目前，对于肺动脉高压患者的术前风险评估或围手术期管理尚无指南。大多数评估围手术期风险因素和死亡率的文献都是观察性的，包括患有多种肺动脉高压病因的患者。患有肺动脉高压的患者，也被称为世界卫生组织第一组肺动脉高压患者，尤其是那些接受肺动脉高压特异性治疗的患者，可能风险更高。这些患者的围手术期管理需要扎实理解并仔细考虑麻醉药物、正压通气以及与手术相关的容量变化对血流动力学的影响，以预防急性右心室衰竭。我们回顾了关于肺动脉高压患者围手术期发病率和死亡率的最新数据，以便更好地指导多学科团队进行术前风险评估和围手术期管理。
