Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2021 Oct 29;111(10b):13424.
Executive summary The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa.The guidelines were developed by updating the Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts. The recommendations in these guidelines are:1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5% (conditional recommendation: moderate-quality evidence).2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence).3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence).4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence).Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities.
执行摘要
南非（SA）心脏病人非心脏手术指南旨在解决南非和更广泛的非洲地区择期非心脏手术患者的心脏风险评估和风险分层需求。该指南是通过更新加拿大心血管学会（Canadian Cardiovascular Society）的围手术期心脏风险评估和管理指南，同时搜索非洲国家和最近出版物的文献而制定的。经过南非麻醉和血管外科专家的德尔菲共识评估，对更新后的建议指南进行了评估。这些指南中的建议如下：
我们建议，45 岁及以上的择期非心脏手术患者，如有冠心病、充血性心力衰竭、中风或短暂性脑缺血发作病史，或 18 岁及以上的血管外科患者，有外周血管疾病病史，需要进一步进行术前风险分层，因为他们预测的 30 天主要不良心脏事件（MACE）风险超过 5%（有条件建议：中等质量证据）。
我们不建议常规进行心血管风险分层检查，用于成人择期非心脏手术（强烈建议：低至中等质量证据）。
我们建议，45 岁及以上有冠心病、中风或短暂性脑缺血发作、充血性心力衰竭病史的择期非心脏手术患者，或 18 岁及以上有外周血管疾病的血管外科患者，应进行术前利钠肽（NP）筛查（强烈建议：高质量证据）。
我们建议，对于 45 岁及以上有冠心病、中风或短暂性脑缺血发作、充血性心力衰竭病史或 18 岁及以上有外周血管疾病病史的择期非心脏手术患者，术后 48-72 小时内应每天测量肌钙蛋白，即（i）术前无 NP 筛查时，择期手术后 30 天内 MACE 的基线风险>5%（ii）术前 B 型利钠肽（BNP）/N-末端前体 B 型利钠肽（NT-proBNP）水平升高（定义为 BNP>99 pg/ml 或 NT-proBNP>300 pg/ml）（有条件建议：中等质量证据）。对于非心脏手术后心肌损伤（MINS）的管理和合并症的药物治疗，也给出了额外的建议。
