Abraham S A, Eagle K A
Cardiac Unit, Massachusetts General Hospital, Boston 02114, USA.
J Nucl Cardiol. 1994 Jul-Aug;1(4):389-98. doi: 10.1007/BF02939960.
Patients presenting for noncardiac surgery should receive careful preoperative cardiac risk stratification. This has implications not only for the perioperative period, but also for long-term survival. After an initial clinical evaluation, certain patients will be referred for noninvasive testing. Those without significant inducible ischemia at a high workload have a low risk for perioperative cardiac complications. Patients who are unable to exercise adequately may require alternative forms of testing, of which dipyridamole thallium scintigraphy is the most thoroughly studied and validated option. Patients with either high-risk clinical profiles or significant thallium redistribution merit consideration for preoperative coronary angiography. Treatment options for high-risk patients include: (1) Proceeding with surgery as planned along with aggressive perioperative monitoring and anti-ischemic therapy, (2) coronary angiography with subsequent myocardial revascularization as appropriate before elective surgery, (3) selecting an alternative, lower risk surgical approach, and (4) cancellation of surgery in lieu of a trial of conservative therapy.
接受非心脏手术的患者应接受仔细的术前心脏风险分层。这不仅对围手术期有影响，而且对长期生存也有影响。经过初步临床评估后，某些患者将被转诊进行非侵入性检查。那些在高负荷状态下无明显诱发性缺血的患者围手术期心脏并发症风险较低。无法充分运动的患者可能需要其他形式的检查，其中双嘧达莫铊闪烁扫描是研究最充分且经过验证的选择。具有高风险临床特征或明显铊再分布的患者值得考虑进行术前冠状动脉造影。高危患者的治疗选择包括：（1）按计划进行手术并加强围手术期监测和抗缺血治疗，（2）在择期手术前进行冠状动脉造影并酌情进行后续心肌血运重建，（3）选择另一种风险较低的手术方法，（4）取消手术转而进行保守治疗试验。
