资源描述：
《cardiovascular disease in ambulatory surgery课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、IanSmith,MD,FRCAEditor,JournalofOne-daySurgery,SeniorLecturerinAnaesthesiaUniversityHospitalofNorthStaffordshireStoke-on-TrentCardiovascularDiseaseinAmbulatorySurgeryRiskAssessment“Despitesophisticatedtechnologies,historyandphysicalexaminationremainthekey
2、elementsofpreoperativeriskassessment”Chassot,etal.—BrJAnaesth89:747,2002CardiacRiskIndexCoronaryarterydisease:MIwithin6mo MI>6moAngina:onmildexercise atminimalexertionPulmonaryoedema:within1week everCriticalaorticstenosisArrhythmias:anyotherthanSRorPAC >5
3、PVCsPoorgeneralmedicalstatusAge>70yearsEmergencysurgery10 510 2010 5205 55510RiskfactorPointsDetsky,etal.—JGenIntMed1:211,1986ClassificationofCardiacRiskMajorriskfactors:MI,CABGorstenting<6weeks anginaonminimalexertionoratrest residualischaemiafollowingMI
4、 ischaemiawithCCFormalignantrhythmMinorriskfactors:MI>3mo revascularisation>3mo (asymptomatic,notreatment)Chassot,etal.—BrJAnaesth89:747,2002Intermediateriskfactors:MI>6weeks,<3mo revascularisation>6weeks,<3mo,or>6years anginaonmoderateorstrenuouseffort p
5、reviousperioperativeischaemia silentischaemia ventriculararrhythmia diabetes age(physiological)>70familyhistoryCAD uncontrolledhypertension highcholesterol smoking abnormalECGMinorriskfactorspredictcoronaryarterydiseasebutnotperioperativeriskToo Complicat
6、ed?4FactorsSevereanginaPreviousMIHeartfailureHypertensionHypertension:WhatweKnowMostimportantriskfactorfor:cerebrovasculardiseasecoronaryheartdiseaseingeneralpopulationMacMahon,etal.—Lancet335:765,1990ControlofelevatedBP:significantlylowersCVS morbidityan
7、dmortalityCollins,etal.—Lancet335:827,1990Hypertension&Surgery:WhatweDon’tKnowIshypertensionasanindependentriskfactor?“plaguedbymuchuncertainty”Doesdelayingreduceperioperativerisk?“unclear”Riskofisolatedsystolichypertension?“uncertain”Confirmingdiagnosis:
8、multiplevssingleBPreading?“notyetassessed”Casadei&Abuzeid— JournalofHypertension23:19,2005RecentPracticeCancellationatpreassessmentclinichypertension:57%ofmedicalreasons,bydoctorMcIntyre,etal.—JournalofClinicalGover
