Westmead Applied Research Centre, University of Sydney, Sydney, NSW.
Westmead Hospital, Sydney, NSW.
Med J Aust. 2023 Jul 3;219(1):30-39. doi: 10.5694/mja2.51988. Epub 2023 Jun 11.
Peri-operative cardiovascular events occur in up to 3% of patients undergoing non-cardiac surgery. Accurate cardiovascular risk assessment is important in the peri-operative setting, as it allows informed and shared decisions regarding the appropriateness of proceeding with surgery, guides surgical and anaesthetic approaches, and may influence the use of preventive medications and post-operative cardiac monitoring. Quantitative risk assessment may also inform a reconsideration of choosing a more limited lower risk type of surgery, or conservative management. Pre-operative cardiovascular risk assessment starts with clinical assessment and should include an estimate of functional capacity. Specialised cardiac investigations are rarely indicated specifically to assess pre-operative cardiovascular risk. The decision regarding cardiac investigations is influenced by the nature, extent and urgency of surgery. The strategy of performing pre-operative revascularisation to improve post-operative outcomes is not evidence-based and recent international guidelines recommend against this.
围手术期心血管事件发生于非心脏手术患者中的比例高达 3%。在围手术期进行准确的心血管风险评估很重要，因为它可以帮助做出有关手术是否适当的知情和共同决策，指导手术和麻醉方法，并可能影响预防性药物的使用和术后心脏监测。定量风险评估还可以提示重新考虑选择风险较低的手术类型或保守治疗。术前心血管风险评估始于临床评估，应包括对功能能力的估计。专门的心脏检查很少专门用于评估术前心血管风险。是否进行心脏检查的决定受手术的性质、范围和紧急程度的影响。术前进行血运重建以改善术后结果的策略没有循证医学证据，最近的国际指南也不推荐这种做法。
