心脏手术前准备指南ppt课件.ppt

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1、GuidelinesforPerioperativeCardiovascularEvaluationforNoncardiacSurgery*AReportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines*EagleKA,BrundageBH,Chaitman,BRetal:Circulation1996;93:1278-1317andJACC1996;27:910-948.©1998AmericanHeartAssociation,I

2、nc.Allrightsreserved.Unauthorizeduseprohibited.CommitteeonPostGraduateEducation,CouncilonClinicalCardiology,AmericanHeartAssociationPreparedby:JamieConti,MDForresterLee,MDPurposeofPreoperativeEvaluationEvaluatepatient’scurrentmedicalstatus.Provideclinicalriskprofile.Providerecomme

3、ndationsformanagementofcardiacriskoverentireperioperativeperiod.RoleoftheConsultantReviewavailablepatientdata,historyandphysicalexamination.Communicateseverityandstabilityofpatient’scardiovascularstatus.Determineifpatientinoptimalmedicalcondition,givencontextofsurgicalillness.Gener

4、alApproachtothePatientHistoryPhysicalExaminationComorbidDiseasesPulmonaryDiabetesMellitusRenalImpairmentHematologicDisordersAncillaryStudiesClinicalPredictorsofIncreasedPerioperativeCardiovascularRiskMajorUnstablecoronarysyndromes.DecompensatedCHF.SignificantArrhythmias.Intermediat

5、eMildanginapectoris.PriorMI.CompensatedorpriorCHF.DiabetesMellitus.MinorAdvancedAge.AbnormalECG.Rhythmotherthansinus.Lowfunctionalcapacity.Historyofstroke.UncontrolledHTN.DiseaseSpecificApproachesCoronaryArteryDisease(CAD).PatientswithknownCAD.PatientswithmajorriskfactorsforCAD.Hyp

6、ertension.CongestiveHeartFailure.ValvularHeartDisease.ArrhythmiasandConductionDefects.PulmonaryVascularDisease.TypeofSurgeryUrgency.Highsurgicalrisk:Aorticandothermajorvascular.Peripheralvascular.Anticipatedprolongedsurgicalproceduresassociatedwithlargefluidshiftsand/orbloodloss.Ty

7、peofSurgeryIntermediatesurgicalrisk:Carotidendarterectomy.Headandnecksurgery.Intraperitonealandintrathoracic,orthopedicandprostatesurgery.TypeofSurgeryLowsurgicalrisk:Endoscopicandsuperficialprocedures.Cataractsurgery.Breastsurgery.SupplementalPreoperativeEvaluationNoninvasiveresti

8、ngleftventricularfunction: