Goldman L
Ann Intern Med. 1983 Apr;98(4):504-13. doi: 10.7326/0003-4819-98-4-504.
When internists are consulted to assess risks and to aid in the perioperative management of surgical patients, they often can rely on substantial clinical data to guide the consultation. Perioperative cardiac risk can be estimated based on the severity of underlying heart failure, the occurrence of a recent myocardial infarction or various arrhythmias, the presence of aortic stenosis, the patient's age, the type of planned surgery (including whether it is an emergency or elective procedure), and the patient's general medical condition. Preoperative exercise testing or cardiac catheterization to assess risk are not routinely indicated, but perioperative hemodynamic monitoring to improve management is recommended in patients at high risk. Postoperative hypertension, arrhythmias, and heart failure commonly occur in the first 2 days after surgery, but the risk of myocardial infarction persists for at least 5 or 6 days after surgery. Effective perioperative consultation must include careful postoperative observation to detect cardiac complications at an early stage and to assist in their management.
当内科医生被咨询以评估手术患者的风险并协助围手术期管理时，他们通常可以依靠大量临床数据来指导会诊。围手术期心脏风险可根据潜在心力衰竭的严重程度、近期心肌梗死或各种心律失常的发生情况、主动脉瓣狭窄的存在、患者年龄、计划手术的类型（包括是否为急诊或择期手术）以及患者的一般医疗状况来估计。术前进行运动试验或心脏导管检查以评估风险并非常规必需，但建议对高危患者进行围手术期血流动力学监测以改善管理。术后高血压、心律失常和心力衰竭通常在术后头2天出现，但心肌梗死的风险在术后至少持续5或6天。有效的围手术期会诊必须包括术后仔细观察，以便早期发现心脏并发症并协助处理。
