Schirmer Stephan H
Kardiopraxis Schirmer, Am Altenhof 8, 67655, Kaiserslautern, Deutschland.
Herz. 2024 Dec;49(6):479-488. doi: 10.1007/s00059-024-05274-x. Epub 2024 Oct 21.
The risk assessment of patients with cardiovascular diseases before noncardiac surgery (NCS) is particularly relevant in cardiology because of the frequency and the involvement of different disciplines. The risk is determined by the operation itself and the disease or risk profile, including the patient's age. Specialist preoperative consultation can therefore remain limited if the surgery-related risk is low. The subjective symptoms (exercise tolerance) and also the determination of the cardiac biomarkers N‑terminal pro-brain natriuretic peptide (NT-proBNP) and troponin are particularly relevant for assessing the indications for an instrumental or specialist examination. Cardiovascular drug treatment should predominantly be continued perioperatively but not initiated just for the operation. There are practical guidelines for pausing oral anticoagulation, whereby a general heparin bridging is no longer recommended.
由于非心脏手术(NCS)前心血管疾病患者风险评估的频繁性以及涉及不同学科,因此在心脏病学中具有特殊意义。风险由手术本身以及疾病或风险状况(包括患者年龄)决定。因此,如果手术相关风险较低,专科术前会诊可能会受到限制。主观症状(运动耐量)以及心脏生物标志物N末端脑钠肽前体(NT-proBNP)和肌钙蛋白的测定对于评估器械检查或专科检查的适应症尤为重要。心血管药物治疗在围手术期应主要持续进行,但不应仅为手术而开始使用。对于暂停口服抗凝治疗有实用指南,目前不再推荐常规使用肝素桥接。