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1、IanSmith,MD,FRCAEditor,JournalofOne-daySurgery,SeniorLecturerinAnaesthesiaUniversityHospitalofNorthStaffordshireStoke-on-TrentCardiovascularDiseaseinAmbulatorySurgeryRiskAssessment“Despitesophisticatedtechnologies,historyandphysicalexaminationremainthekeyelementsofpreoperativeriskass
2、essment”Chassot,etal.—BrJAnaesth89:747,2002CardiacRiskIndexCoronaryarterydisease:MIwithin6mo MI>6moAngina:onmildexercise atminimalexertionPulmonaryoedema:within1week everCriticalaorticstenosisArrhythmias:anyotherthanSRorPAC >5PVCsPoorgeneralmedicalstatusAge>70yearsEmergencysurgery10
3、510 2010 5205 55510RiskfactorPointsDetsky,etal.—JGenIntMed1:211,1986ClassificationofCardiacRiskMajorriskfactors:MI,CABGorstenting<6weeks anginaonminimalexertionoratrest residualischaemiafollowingMI ischaemiawithCCFormalignantrhythmMinorriskfactors:MI>3mo revascularisation>3mo (asympt
4、omatic,notreatment)Chassot,etal.—BrJAnaesth89:747,2002Intermediateriskfactors:MI>6weeks,<3mo revascularisation>6weeks,<3mo,or>6years anginaonmoderateorstrenuouseffort previousperioperativeischaemia silentischaemia ventriculararrhythmia diabetes age(physiological)>70familyhistoryCAD u
5、ncontrolledhypertension highcholesterol smoking abnormalECGMinorriskfactorspredictcoronaryarterydiseasebutnotperioperativeriskToo Complicated?4FactorsSevereanginaPreviousMIHeartfailureHypertensionHypertension:WhatweKnowMostimportantriskfactorfor:cerebrovasculardiseasecoronaryheartdis
6、easeingeneralpopulationMacMahon,etal.—Lancet335:765,1990ControlofelevatedBP:significantlylowersCVS morbidityandmortalityCollins,etal.—Lancet335:827,1990Hypertension&Surgery:WhatweDon’tKnowIshypertensionasanindependentriskfactor?“plaguedbymuchuncertainty”Doesdelayingreduceperioperativ
7、erisk?“unclear”Riskofisolatedsystolichypertension?“uncertain”Confirmingdiagnosis:multiplevssingleBPreading?“notyetassessed”Casadei&Abuzeid— JournalofHypertension23:19,2005RecentPracticeCancellationatpreassessmentclinichypertension:57%ofmedicalreasons,bydoctorMcIntyre,etal.—JournalofC
8、linicalGover
