Guarracino F, Baldassarri R, Priebe H J
Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy -
Minerva Anestesiol. 2015 Feb;81(2):226-33. Epub 2014 Nov 11.
Each year, an increasing number of elderly patients with cardiovascular disease undergoing non-cardiac surgery require careful perioperative management to minimize the perioperative risk. Perioperative cardiovascular complications are the strongest predictors of morbidity and mortality after major non-cardiac surgery. A Joint Task Force of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) has recently published revised Guidelines on the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery, which represent the official position of the ESC and ESA on various aspects of perioperative cardiac care. According to the Guidelines effective perioperative cardiac management includes preoperative risk stratification based on preoperative assessment of functional capacity, type of surgery, cardiac risk factors, and cardiovascular function. The ESC/ESA Guidelines discourage indiscriminate routine preoperative cardiac testing, because it is time- and cost-consuming, resource-limiting, and does not improve perioperative outcome. They rather emphasize the importance of individualized preoperative cardiac evaluation and the cooperation between anesthesiologists and cardiologists. We summarize the relevant changes of the 2014 Guidelines as compared to the previous ones, with particular emphasis on preoperative cardiac testing.
每年，越来越多患有心血管疾病且需接受非心脏手术的老年患者需要精心的围手术期管理，以将围手术期风险降至最低。围手术期心血管并发症是大型非心脏手术后发病率和死亡率的最强预测因素。欧洲心脏病学会（ESC）和欧洲麻醉学会（ESA）联合工作组最近发布了关于计划接受非心脏手术患者围手术期心血管管理的修订指南，这些指南代表了ESC和ESA在围手术期心脏护理各方面的官方立场。根据这些指南，有效的围手术期心脏管理包括基于对功能能力、手术类型、心脏危险因素和心血管功能的术前评估进行术前风险分层。ESC/ESA指南不鼓励不加区分地进行常规术前心脏检查，因为这既耗时又费钱，还会限制资源，并且不会改善围手术期结局。它们更强调个体化术前心脏评估以及麻醉医生和心脏病医生之间合作的重要性。我们总结了2014年指南与之前指南相比的相关变化，尤其着重于术前心脏检查。
