心脏病人接受非心脏手围术期评估课件.pptVIP

* * There are potential discrepancies between a CPET（Cardiopulmonary exercise testing） and functional assessment using METs that preclude a widespread use of CPET. * * * * * 仔细对比，ESA与AHA对于UCG指征有较大区别，ESA强调了外科大手术，而AHA强调了病人的合并内科疾病(CLASS Ⅱa Level C),但是都有严格指征： 1. It is reasonable for patients with dyspnea of unknown origin to undergo preoperative evaluation of LV function. 2. It is reasonable for patients with current or prior HF with worsening dyspnea or other change in clinical status to undergo preoperative evaluation of LV function if not performed within 12 months. 3. Routine perioperative evaluation of LV function in patients is not recommended.（ClassⅢ level B）. Prognostic Implications of Asymptomatic LV Dysfunction in Patients Undergoing Vascular Surgery. Anesthesiology: June 2010:1316-1324. Conclusion: ……preoperative risk stratification should include not only solely heart failure symptoms but also routine preoperative echocardiography to risk stratify open vascular surgery patients. Diastolic Function: A Barometer for Cardiovascular Risk? Anesthesiology: June 2010:1303-1306. Conclusion: it is our opinion that there has evolved strong enough support for the following modification of the 2009 ACC/AHA Preoperative Cardiac Risk Assessment Guidelines: Resting echocardiography for assessment of LV systolic and diastolic function in asymptomatic patients undergoing high-risk noncardiac surgery is recommended(这正好是ESA指征). * BNP-- 诊断心力衰竭唯一有效的血液生化指标，特别有助于呼吸困难的原因是心力衰竭拟或肺疾患等非心源性疾病的鉴别诊断; 血浆BNP浓度＞100pg/ml为心衰诊断标准，＜80pg/ml为心衰排除标准; 此外，血浆BNP浓度与心衰程度有很好的相关性; BNP的检测对心衰的早期诊断、心衰程度的评估、心衰的治疗疗效监测和预后判断均具有重要的临床价值; * CLASS III Level C 1. Noninvasive testing is not useful for patients with no clinical risk factors undergoing intermediate-risk noncardiac surgery 2. Noninvasive testing is not useful for patients undergoing low-risk noncardiac surgery. * CTA--必须克服心跳和呼吸产生的运动伪影,最好心率70次/min。其图像质量决定于时间分辨力和空间分辨力。 CAC--ACC/AHA指南，推荐用于对于中度冠心病危险的患者，冠状动脉钙化病变的存在与患者预后密切相关。冠状动脉钙化积分较高的患者可能应重新分类为高度冠