Michaels J A, Payne S P, Galland R B
Department of Surgery, Royal Berkshire Hospital, Reading, U.K.
Eur J Vasc Endovasc Surg. 1996 Feb;11(2):221-4. doi: 10.1016/s1078-5884(96)80056-6.
To assess the frequency with which various methods of cardiac risk assessment are used prior to major vascular surgery and the way in which patients considered to the "high" risk are managed.
Questionnaire survey.
Great Britain and Northern Ireland.
Vascular Surgeons who are current members of the Vascular Surgical Society of Great Britain and Northern Ireland.
Number of respondents reporting routine or frequent use of particular investigations and methods of management.
Of 246 respondents, 52% had access to a high dependency unit and 77% used intensive therapy units routinely following aortic reconstruction. Some measure of ejection fraction was the most common investigation and was used routinely prior to aortic reconstruction by 35% and often by 33% of respondents, this being more frequent in respondents from teaching hospitals and those carrying out a greater number of reconstructions. Calculated clinical risk indices were rarely used. The identification of high risk patients led to referral to a cardiologist for 90% of respondents and influenced the choice of anaesthetist for 50%.
It is concluded that there is considerable variation in practice, but that those who carry out more vascular surgery are more aggressive in their assessment of cardiac risk prior to reconstruction.
评估在进行大血管手术前使用各种心脏风险评估方法的频率，以及对被认为“高”风险患者的管理方式。
问卷调查。
大不列颠及北爱尔兰。
大不列颠及北爱尔兰血管外科学会的现任血管外科医生。
报告常规或频繁使用特定检查和管理方法的受访者人数。
在246名受访者中，52%的人可以使用高依赖病房，77%的人在主动脉重建后常规使用重症监护病房。射血分数的某种测量方法是最常见的检查，35%的受访者在主动脉重建前常规使用，33%的受访者经常使用，在教学医院的受访者以及进行更多重建手术的受访者中更为频繁。很少使用计算得出的临床风险指数。对于90%的受访者来说，识别出高风险患者会导致转诊给心脏病专家，对于50%的受访者来说，这会影响麻醉师的选择。
得出的结论是，实践中存在相当大的差异，但进行更多血管手术的医生在重建前对心脏风险的评估更为积极。
