Smit-Fun Valérie, Buhre Wolfgang F
aDepartment of Anesthesiology and Pain Medicine, Maastricht University Medical Center+ bSchool for Mental Health and Neuroscience (MheNS), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
Curr Opin Anaesthesiol. 2016 Jun;29(3):391-6. doi: 10.1097/ACO.0000000000000335.
Congestive heart failure (CHF) is one of the most common diseases of the elderly patient. The underlying pathophysiology varies considerably and approximately 50% of the patients suffer from CHF with reduced left ventricular ejection fraction. Mortality in the perioperative period is increased in patients with CHF and this holds true for both minor and major surgeries. This review will summarize recent literature in the field of CHF and perioperative outcome in patients undergoing surgery with a special emphasis on actual guidelines, preoperative assessment and appropriate perioperative therapy.
In the past 18 months, new insights in the short and long-term effects of CHF in the perioperative period have been published. The role of left ventricular ejection fraction has been studied in noncardiac surgical patients and it has been demonstrated that an ejection fraction less than 30% is associated with a significant increase in mortality and myocardial infarctions. Moreover, in 25% of patients, acute exacerbation of heart failure takes place in the perioperative period. The European Society of Anesthesiology published new guidelines on the preoperative evaluation of patients with CHF. The role of adequate preoperative evaluation and preparation of patients with CHF is discussed widely. It becomes clear that parameters like brain natriuretic peptide play a crucial role in risk stratification and prediction of outcome. Also, the treatment of patients with low cardiac output was a topic, and it became clear that established therapies including the use of β-mimetics and PDE-III inhibitors should only be initiated in very selected patient groups. However, adequately powered studies in patients with CHF are still missing and the majority of knowledge is based on patient undergoing cardiac surgery.
CHF is a source of considerable perioperative morbidity and mortality and in contrast to coronary artery disease, knowledge is very limited and additional research urgently needed.
充血性心力衰竭（CHF）是老年患者最常见的疾病之一。其潜在的病理生理学差异很大，约50%的患者患有左心室射血分数降低的CHF。CHF患者围手术期死亡率增加，无论大小手术均如此。本综述将总结CHF领域以及接受手术患者围手术期结局的近期文献，特别强调实际指南、术前评估和适当的围手术期治疗。
在过去18个月里，已发表了关于CHF在围手术期短期和长期影响的新见解。已在非心脏手术患者中研究了左心室射血分数的作用，结果表明射血分数低于30%与死亡率和心肌梗死显著增加相关。此外，25%的患者在围手术期发生心力衰竭急性加重。欧洲麻醉学会发布了关于CHF患者术前评估的新指南。广泛讨论了对CHF患者进行充分术前评估和准备的作用。很明显，脑钠肽等参数在风险分层和结局预测中起关键作用。此外，低心输出量患者的治疗也是一个话题，很明显，包括使用β-拟交感神经药和磷酸二酯酶III抑制剂在内的既定疗法仅应在非常特定的患者群体中启动。然而，仍缺乏对CHF患者进行的充分有力研究，且大多数知识基于接受心脏手术的患者。
CHF是围手术期相当大的发病和死亡来源，与冠状动脉疾病不同，相关知识非常有限，迫切需要更多研究。
