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非心脏手术中的心血管事件应对:并发症与风险评估策略的全面综述

Navigating Cardiovascular Events in Non-Cardiac Surgery: A Comprehensive Review of Complications and Risk Assessment Strategies.

作者信息

Shuja Muhammad Hamza, Sajid Areeba, Anwar Eman, Sajid Barka, Larik Muhammad Omar

机构信息

Department of Medicine, Dow Medical College, Karachi, Pakistan.

Department of Medicine, Aga Khan University, Karachi, Pakistan.

出版信息

J Cardiothorac Vasc Anesth. 2025 Mar;39(3):792-802. doi: 10.1053/j.jvca.2024.09.149. Epub 2024 Oct 2.

Abstract

Cardiovascular complications following non-cardiac surgery pose a significant global concern, affecting millions of patients annually. These complications, ranging from asymptomatic troponin elevations to major adverse cardiac events, contribute to heightened morbidity, mortality, and health care expenditures. The underlying mechanisms involve oxygen supply-demand imbalances and acute coronary syndromes precipitated by perioperative stressors. High-risk surgeries, including vascular and major abdominal procedures, are particularly susceptible to these complications. Risk assessment tools and biomarkers, especially high-sensitivity cardiac troponins, play pivotal roles in prognostication. However, despite advances in perioperative care, optimal management strategies remain elusive, as underscored by conflicting guidelines regarding interventions such as β-blockers and statins. This review aims to consolidate current evidence on cardiovascular complications following non-cardiac surgery, evaluate the utility of biomarkers, and discuss international guidelines for risk mitigation. An enhanced understanding regarding the standardized approaches is imperative in mitigating these complications effectively. Further research is essential to refine risk prediction models, validate biomarker thresholds, and elucidate the efficacy of preventive measures. Addressing these challenges can eventually lead to improved patient outcomes and more efficient healthcare resource utilization worldwide.

摘要

非心脏手术后的心血管并发症是一个重大的全球问题,每年影响数百万患者。这些并发症,从无症状肌钙蛋白升高到重大不良心脏事件,导致发病率、死亡率升高以及医疗保健费用增加。潜在机制包括围手术期应激源引发的氧供需失衡和急性冠状动脉综合征。高风险手术,包括血管手术和大型腹部手术,尤其容易出现这些并发症。风险评估工具和生物标志物,特别是高敏心肌肌钙蛋白,在预后评估中发挥关键作用。然而,尽管围手术期护理取得了进展,但最佳管理策略仍然难以捉摸,关于β受体阻滞剂和他汀类药物等干预措施的指南相互矛盾就凸显了这一点。本综述旨在整合非心脏手术后心血管并发症的现有证据,评估生物标志物的效用,并讨论降低风险的国际指南。有效减轻这些并发症,增强对标准化方法的理解势在必行。进一步的研究对于完善风险预测模型、验证生物标志物阈值以及阐明预防措施的疗效至关重要。应对这些挑战最终可改善全球患者的预后并提高医疗资源利用效率。

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