心脏病人非心脏手术术前评估与术中管理杨柳青.ppt

心脏病人非心脏手术术前评估与术中管理 江苏省苏北人民医院麻醉科 杨柳青 The Preamble Introduction The present guidelines focus on the cardiological management of patients undergoing non-cardiac surgery, i.e. patients where heart disease is a potential source of complications during surgery major non-cardiac surgery is associated with an incidence of cardiac death of between 0.5 and 1.5%, and of major cardiac complications of between 2.0 and 3.5% Impact of the ageing population It is estimated that elderly people require surgery four times more often than the rest of the population Pre-operative evaluation Surgical risk for cardiac events: the urgency, magnitude, type, and duration of the procedure, as well as the change in body core temperature, blood loss, and fluid shifts Functional capacity Functional capacity is measured in metabolic equivalents (METs) Exercise testing provides an objective assessment of functional capacity Without testing, functional capacity can be estimated by the ability to perform the activities of daily living Risk indices Goldman (1977), Detsky (1986), Lee (1999) The Lee index, to be the best currently available cardiac risk prediction index in non-cardiac surgery Six independent clinical determinants (The Lee index) a history of IHD a history of cerebrovascular disease heart failure insulin-dependent diabetes mellitus impaired renal function High-risk type of surgery The Lee index All factors contribute equally to the index (with 1 point each) the incidence of major cardiac complications is estimated at 0.4, 0.9, 7,and 11% in patients with an index of 0, 1, 2, and ≥ 3 points, respectively Biomarkers Cardiac troponins T and I (cTnT and cTnI) are the preferred markers for the diagnosis of MI because they demonstrate sensitivity and tissue specificity superior to other available biomarkers Plasma BNP and NT-proBNP important prognostic indicators in patients with heart failure additional prognostic value for long-term mortality and for cardiac events N