Savery Kelsey E, Kleiman Amanda M, Walters Susan M
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.
Clin Colon Rectal Surg. 2023 Jan 28;36(3):167-174. doi: 10.1055/s-0043-1760869. eCollection 2023 May.
More than 50 million surgical procedures are carried out every year in the United States with the estimated risk of major adverse cardiac events perioperatively between 1.4 and 3.9%. Given that the majority of surgeries are elective, this allows ample opportunity to identify patients at higher risk of perioperative adverse events and optimize them for surgery. Preexisting cardiopulmonary disease is a major risk factor for adverse events perioperatively and can lead to significant morbidity and mortality. It can predispose patients to perioperative myocardial ischemia and infarction, perioperative pulmonary complications, and perioperative stroke among other complications. This article details an approach to preoperative interview and examination, indications for preoperative testing, and strategies for optimization in patients with underlying cardiopulmonary disease. It also includes guidelines on optimal timing of elective surgery in certain clinical scenarios that can escalate perioperative risk. Through the use of thorough preoperative assessment, targeted preoperative testing, and multidisciplinary optimization of preexisting disease, perioperative risk can be decreased significantly and perioperative outcomes improved.
在美国，每年进行超过5000万例外科手术，围手术期发生重大不良心脏事件的估计风险在1.4%至3.9%之间。鉴于大多数手术都是择期手术，这就有足够的机会识别围手术期不良事件风险较高的患者，并使其手术状态达到最佳。既往存在的心肺疾病是围手术期不良事件的主要危险因素，可导致显著的发病率和死亡率。它可使患者易发生围手术期心肌缺血和梗死、围手术期肺部并发症以及围手术期中风等其他并发症。本文详细介绍了针对合并心肺疾病患者的术前问诊和检查方法、术前检查的指征以及优化策略。它还包括在某些可能增加围手术期风险的临床情况下择期手术最佳时机的指南。通过全面的术前评估、有针对性的术前检查以及对现有疾病的多学科优化，可以显著降低围手术期风险并改善围手术期结局。
