Froehlich J B
Department of Internal Medicine, University of Michigan Hospital, Ann Arbor 48109-0273, USA.
Prog Cardiovasc Dis. 1998 Mar-Apr;40(5):373-81. doi: 10.1016/s0033-0620(98)80012-1.
Perioperative cardiac events are the largest cause of morbidity and mortality for patients undergoing elective surgery. As a result, numerous recent studies have focused on attempts to identify patients at increased risk for perioperative events. These have delineated testing modalities capable of identifying high-risk patients, and clinical markers which further stratify patients facing elective surgery into high-, medium-, and low-risk subgroups. In this article, the authors review the evidence supporting the use of clinical markers of risk to evaluate patients before elective surgery. The role of preoperative clinical assessment in identifying patients most likely to benefit from further testing or intervention, (ie, those at significant risk for short- and long-term cardiac events) is stressed. Assessment and intervention for risk factors of long-term cardiac disease is also stressed, as the preoperative evaluation represents an opportunity for improvement in the short- and long-term cardiac risk profile. Finally, the algorithm for preoperative cardiovascular evaluation published jointly by the ACC/AHA joint taskforce on practice guidelines is reviewed. This algorithm is a synthesis of the current literature, into a cost effective and efficient approach to patient evaluation.
围手术期心脏事件是接受择期手术患者发病和死亡的最大原因。因此，最近大量研究集中于试图识别围手术期事件风险增加的患者。这些研究已经明确了能够识别高危患者的检测方式，以及将面临择期手术的患者进一步分层为高、中、低风险亚组的临床指标。在本文中，作者回顾了支持使用风险临床指标在择期手术前评估患者的证据。强调了术前临床评估在识别最有可能从进一步检测或干预中获益的患者（即那些有短期和长期心脏事件显著风险的患者）中的作用。还强调了对长期心脏病危险因素的评估和干预，因为术前评估是改善短期和长期心脏风险状况的一个机会。最后，回顾了美国心脏病学会（ACC）/美国心脏协会（AHA）实践指南联合工作组联合发布的术前心血管评估算法。该算法是将当前文献综合成一种经济有效且高效的患者评估方法。
