Evaluation and Prevention of Cardiac Risks in the Patients Undergoing Noncardiac Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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贾乾斌

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Keywords：

非心脏外科手术; 心脏危险因素; 筛选检查; 预防

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随着人口的老龄化，越来越多的有症状或无症状的冠心病患者需接受非心脏外科手术。接受非心脏外科手术而死亡的患者大约有50%是由于心脏并发症所致［1］。围手术期发生的心脏并发症大约5%～10%为心肌梗死，主要发生于术后头3天，其病死率很高，可达32%～69%［2，3］。术后发生心肌梗死或不稳定型心绞痛的患者发生心血管问题的几率增加20倍［4］。因此，如何评估非心脏外科手术患者的心脏危险性，如何预防围手术期心脏并发症的发生，已成为外科医生十分关注的一个问题。

Citation： 贾乾斌. Evaluation and Prevention of Cardiac Risks in the Patients Undergoing Noncardiac Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(3): 297-301. doi: Copy

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2.	Yeager RA, Moneta GL, Edwards JM, et al. Late survival after perioperative myocardial infarction complicating vascular surgery [J]. J Vasc Surg, 1994; 20（4）∶598.
3.	Charlson M, Peterson J, Szatrowski TP, et al. Longterm prognosis after perioperative cardiac complications [J]. J Clin Epidemiol, 1994; 47(12)∶1389.
4.	Mangano DT, Browner WS, Hollenberg M, et al. Longterm cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group [J]. JAMA, 1992; 268(2)∶233.
5.	Murabito JM, Evans JC, Larson MG, et al. Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation [J]. Circulation, 1993; 88(6)∶2548.
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7.	Taylor LM Jr, Yeager RA, Moneta GL, et al. The incidence of perioperative myocardial infarction in general vascular surgery [J]. J Vasc Surg, 1991; 15(1)∶52.
8.	Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) [J]. J Am Coll Cardiol, 1996; 27(4)∶910.
9.	Poldermans D, Arnese M, Fioretti PM, et al. Sustained prognostic value of dobutamine stress echocardiography for late cardiac events after major noncardiac vascular surgery [J]. Circulation, 1997; 95(1)∶53.
10.	Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures [J]. N Engl J Med, 1977; 297(16)∶845.
11.	Wilt TJ, Davis BR, Meyers DG, et al. Prevalence and correlates of symptomatic peripheral atherosclerosis in individuals with coronary heart disease and cholesterol levels less than 240 mg/dl: baseline results from the cholesterol and recurrent events (CARE) study [J]. Angiology, 1996; 47(6)∶533.
12.	Detsky AS, Abrams HB, Forbath N, et al. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index [J]. Arch Intern Med, 1986; 146(11)∶2131.
13.	Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery [J]. Ann Intern Med, 1989; 110(11)∶859.
14.	Reilly DF, McNeely MJ, Doerner D, et al. Selfreported exercise tolerance and the risk of serious perioperative complications [J]. Arch Intern Med, 1999; 159(18)∶2185.
15.	Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgeryexecutive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) [J]. Circulation, 2002; 105(10)∶1257.
16.	Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: Role of clinical characteristics, dobutamine echocardiography, and betablocker therapy [J]. JAMA, 2001; 285(14)∶1865.
17.	Oliver MF, Goldman L, Julian DG, et al. Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT) [J]. Anesthesiology, 1999; 91(4)∶951.
18.	Gottlieb A, Banoub M, Sprung J, et al. Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty [J]. J Cardiothorac Vasc Anesth, 1998; 12(5)∶501.
19.	Posner KL, Van Norman GA, Chan V. Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty [J]. Anesth Analg, 1999; 89(3)∶553.
20.	Eagle KA, Rihal CS, Mickel MC, et al. Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3 368 operations. CASS Investigators and University of Michigan Heart Care Program. Coronary Artery Surgery Study [J]. Circulation, 1997; 96(6)∶1882.
21.	Kaul TK, Fields BL, Wyatt DA, et al. Surgical management in patients with coexistent coronary and cerebrovascular disease. Longterm results [J]. Chest, 1994; 106(5)∶1349.
22.	Trachiotis GD, Pfister AJ. Management strategy for simultaneous carotid endarterectomy and coronary revascularization [J]. Ann Thorac Surg, 1997; 64(4)∶1013.
23.	Gersh BJ, Rihal CS, Rooke TW, et al. Evaluation and management of patients with both peripheral vascular and coronary artery disease [J]. J Am Coll Cardiol, 1991; 18(1)∶203.
24.	Blackbourne LH, Tribble CG, Langenburg SE, et al. Optimal timing of abdominal aortic aneurysm repair after coronary artery revascularization [J]. Ann Surg, 1994; 219(6)∶693.
25.	Frank SM,Fleisher LA,Breslow MJ,et al.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial [J].JAMA,1997; 277(14)∶1127.

1. Mangano DT. Perioperative cardiac morbidity [J]. Anesthesiology, 1990; 72（1）∶153.
2. Yeager RA, Moneta GL, Edwards JM, et al. Late survival after perioperative myocardial infarction complicating vascular surgery [J]. J Vasc Surg, 1994; 20（4）∶598.
3. Charlson M, Peterson J, Szatrowski TP, et al. Longterm prognosis after perioperative cardiac complications [J]. J Clin Epidemiol, 1994; 47(12)∶1389.
4. Mangano DT, Browner WS, Hollenberg M, et al. Longterm cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group [J]. JAMA, 1992; 268(2)∶233.
5. Murabito JM, Evans JC, Larson MG, et al. Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation [J]. Circulation, 1993; 88(6)∶2548.
6. Coley CM, Field TS, Abraham SA, et al. Usefulness of dipyridamolethallium scanning for preoperative evaluation of cardiac risk for nonvascular surgery [J]. Am J Cardiol, 1992; 69(16)∶1280.
7. Taylor LM Jr, Yeager RA, Moneta GL, et al. The incidence of perioperative myocardial infarction in general vascular surgery [J]. J Vasc Surg, 1991; 15(1)∶52.
8. Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) [J]. J Am Coll Cardiol, 1996; 27(4)∶910.
9. Poldermans D, Arnese M, Fioretti PM, et al. Sustained prognostic value of dobutamine stress echocardiography for late cardiac events after major noncardiac vascular surgery [J]. Circulation, 1997; 95(1)∶53.
10. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures [J]. N Engl J Med, 1977; 297(16)∶845.
11. Wilt TJ, Davis BR, Meyers DG, et al. Prevalence and correlates of symptomatic peripheral atherosclerosis in individuals with coronary heart disease and cholesterol levels less than 240 mg/dl: baseline results from the cholesterol and recurrent events (CARE) study [J]. Angiology, 1996; 47(6)∶533.
12. Detsky AS, Abrams HB, Forbath N, et al. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index [J]. Arch Intern Med, 1986; 146(11)∶2131.
13. Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery [J]. Ann Intern Med, 1989; 110(11)∶859.
14. Reilly DF, McNeely MJ, Doerner D, et al. Selfreported exercise tolerance and the risk of serious perioperative complications [J]. Arch Intern Med, 1999; 159(18)∶2185.
15. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgeryexecutive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) [J]. Circulation, 2002; 105(10)∶1257.
16. Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: Role of clinical characteristics, dobutamine echocardiography, and betablocker therapy [J]. JAMA, 2001; 285(14)∶1865.
17. Oliver MF, Goldman L, Julian DG, et al. Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT) [J]. Anesthesiology, 1999; 91(4)∶951.
18. Gottlieb A, Banoub M, Sprung J, et al. Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty [J]. J Cardiothorac Vasc Anesth, 1998; 12(5)∶501.
19. Posner KL, Van Norman GA, Chan V. Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty [J]. Anesth Analg, 1999; 89(3)∶553.
20. Eagle KA, Rihal CS, Mickel MC, et al. Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3 368 operations. CASS Investigators and University of Michigan Heart Care Program. Coronary Artery Surgery Study [J]. Circulation, 1997; 96(6)∶1882.
21. Kaul TK, Fields BL, Wyatt DA, et al. Surgical management in patients with coexistent coronary and cerebrovascular disease. Longterm results [J]. Chest, 1994; 106(5)∶1349.
22. Trachiotis GD, Pfister AJ. Management strategy for simultaneous carotid endarterectomy and coronary revascularization [J]. Ann Thorac Surg, 1997; 64(4)∶1013.
23. Gersh BJ, Rihal CS, Rooke TW, et al. Evaluation and management of patients with both peripheral vascular and coronary artery disease [J]. J Am Coll Cardiol, 1991; 18(1)∶203.
24. Blackbourne LH, Tribble CG, Langenburg SE, et al. Optimal timing of abdominal aortic aneurysm repair after coronary artery revascularization [J]. Ann Surg, 1994; 219(6)∶693.
25. Frank SM,Fleisher LA,Breslow MJ,et al.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial [J].JAMA,1997; 277(14)∶1127.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation and Prevention of Cardiac Risks in the Patients Undergoing Noncardiac Surgery

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