非心脏手术围手术期心血管并发症的临床评价和危险因素干预

详尽的介绍了心脏危险性临床评价的方法，内容，步骤，并提出了具体的围手术期心血管危险因素的术前干预措施。     

非心脏手术围手术期心血管事件风险评估体系比较

心血管事件是非心脏手术术后主要的死亡原因之一,围手术期心血管事件发病率高且危害大,若术前对围手术期心血管事件发生率进行评估、预测,并采取有效的干预措施,便可降低心血管事件的发生率.现针对非心脏手术围手术期心血管事件风险评估体系内容及其比较展开综述.     

老年非心脏手术围手术期心血管并发症危险因素分析

目的　探讨非心脏手术围手术期心血管并发症的影响因素。方法　将 1988年至 1997年住院的 6 0岁至 99岁大中型非心脏手术患者 16 5 8例分为心血管并发症组和无心血管并发症组 ,对比分析两组年龄、性别、手术类型、内科主要疾病史等对围手术期心血管并发症的影响 ,并探讨其发生的时间分布。结果　 2 72例心血管并发症中 80 %以上发生在术中及术后 72h以内。心血管并发症组平均年龄 (6 9± 6 )岁 ,无心血管并发症组 (6 7± 6 )岁(P <0 .0 1)。与无心血管并发症相比 ,心血管并发症组年龄≥ 70岁、男性、急诊手术、肺叶切除术、前列腺摘除术多。心血管并发症组心血管疾病及其他内科疾病史及体征 ,特别是患有两种以上心血管疾病及其他内科疾病者较无心血管并发症组显著增多 (38.6 %比 18.6 %和 5 7.4 %比 32 .0 % ,P <0 .0 0 1)。结论　年龄、性别、手术类型、心血管和其他内科病史及体征 ,尤其是患有两种以上心血管及其他内科病是老年非心脏手术围手术期心血管并发症发生的主要危险因素。术中、术后 72h内是心血管并发症的高发期 ,应严密监测 ,积极防治。     

老年非心脏手术患者体力活动指数与心血管危险因素的关系

体能是有氧代谢允许的活动能力，被国外许多学者用于衡量老年患者对手术和麻醉承受能力。大量研究已经证实低体能伴随着较高的围手术期心脏事件（CRE）发生率。本研究选用拟行择期非心脏手术的老年患者，探讨随着危险因素增加，患者的体力活动指数（duke activity status index，DASI）的变化。     

高血压患者非心脏手术围手术期心血管并发症的研究

目的:探讨高血压患者非心脏手术围手术期心血管并发症及心血管药物干预的影响。方法:回顾分析101例高血压患者非心脏大、中手术(观察组)的临床资料,与血压正常者64例(对照组)作比较。结果:观察组的心血管并发症明显高于对照组(P<0.05);硬膜外麻醉并发症明显高于对照组(P<0.05);腹部手术并发症明显高于对照组(P<0.05)。结论:高血压病明显增加非心脏手术围手术期心血管并发症。     

非心脏手术围手术期心肌缺血与心脏事件的相关因素

明确与围手术心肌缺血之相关因素及手术后心脏事件发生的关系,以期提出预防措施,减少围手术期心脏事件的发生。方法 观察102例老年患者围手术期有无心肌缺血及心脏事件发生。结果 发生围手术期缺血有38例,86.8%表现为无症状心肌缺血,仅5例（13.2%）有症状。患有糖尿病、原发性高血压、心绞痛、有心衷病史的患者围手术期缺血发生明显增高。有糖尿病患者高3.5倍,有心衰者高5.4倍。有围手术期缺血的患者发生围手术期心脏并发症的比例明显增高（高11倍）。结论 围手术期心肌缺血是围手术期心及事件发生的预警指标：围手术期心肌缺血（包括心肌梗死）大部分为无症状心肌缺血;有心绞痛和心衰病史的患者围手术期心肌缺血的发生明显增高。     

陈旧性心肌梗死对冠心病患者非心脏手术围手术期心脏事件的影响

目的 :探讨陈旧性心肌梗死对冠心病患者非心脏手术围手术期心脏事件的影响。方法 :1988年至 1997年连续收住我院的 45岁至 99岁大中型非心脏手术冠心病患者 12 5 9例 ,分为陈旧性心肌梗死组 (n =76)和非陈旧性心肌梗死组 (n =1183 ) ,对比分析手术类型、内科主要疾病史、术中术后主要心血管并发症等。结果 :两组手术类型和麻醉方式及心血管疾病史无显著性差异 ;与非陈旧性心肌梗死组相比 ,陈旧性心肌梗死组术前心功能不全、左心室射血分数≤ 0 5 0、肾功能不全和有心绞痛症状者多 ,心电图有缺血改变者少 ,两者比较有显著性差异 (P <0 0 5～ 0 0 1)。术中两组心血管并发症发生率无显著性差异。控制年龄和性别后与非陈旧性心肌梗死组相比 ,陈旧性心肌梗死组术后心肌梗死和心源性肺水肿的比数比 (OddsRatio ,OR)及 95 %可信区间分别是 19 3(5 6～ 66 2 ) ,5 7(2 5～ 12 9)。结论 :陈旧性心肌梗死患者非心脏手术术前心肾功能不全者多 ,有心绞痛症状者多 ,围手术期心脏事件发生率高且重。     

老年非心脏手术围术期心律失常的相关因素

心律失常是老年患者围术期很常见的一种心血管并发症,严重的心律失常是导致围术期患者死亡的一个重要原因[1].因此,如何积极预防和治疗围术期严重心律失常是确保患者安全渡过围术期的重要措施.本研究采用动态心电图监测老年非心脏择期手术患者,旨在探讨老年非心脏手术围术期心律失常的相关因素,积极预防和治疗相关危险因素,保障老年患者围术期安全.     

他汀药能降低接受非心脏手术患者围术期的心血管并发症

通常认为,接受非心脏手术患者之所以有惊人的并发症,主要是由于手术后常易发生心血管并发症．而他汀药巳被证实能降低冠心病患者的心脏并发症与死亡率．且该裨益作用早在所能检测到的冠脉内径扩张前即已显现．作者特推测他汀药对接受非心脏手术患者亦有裨益,并对接受非心脏手术患者围术期心血管并发症与他汀药用药间关系进行了初评．     

About cardiovascular risk in non-cardiac surgery

The perioperative management of patients at risk for cardiovascular diseases who undergo non-cardiac surgery has been subject of debate over the past few decades and is still of great interest. An adequate perioperative management may modify postoperative mortality and morbidity and may improve the long-term prognosis. The purpose of this review is to examine the present day knowledge regarding the preoperative evaluation and perioperative and postoperative management. In spite of the available guidelines (the American College of Cardiology and the American Heart Association of 1996) and of several studies on this subject, many controversies still persist. The main questions are: 1) the preoperative cardiovascular evaluation through non-invasive tests (and the true predictive value of the increased cardiovascular risk) and 2) the real benefit of coronary revascularization before non-cardiac surgery. The last part of this review highlights many recent clinical observations and experimental studies regarding the efficacy of the extensive use of beta-adrenergic receptor blockers and optimized anti-ischemic pharmacological therapy in reducing the cardiovascular risk of non-cardiac surgery and in improving the long-term prognosis.     

Subclinical atherosclerosis among rheumatoid arthritis patients without overt cardiovascular risk factors

Abstract

Objective. To determine the associated factors of subclinical atherosclerosis measured with carotid intima media thickness (CIMT) among rheumatoid arthritis (RA) patients without any overt traditional cardiovascular (CV) risk factors.

Methods. Forty RA patients with matched age and gender healthy controls were recruited. Carotid ultrasound was performed to all subjects. CIMT was considered to be abnormally thickened if it was more than the 75th percentile matched for age and sex reference values. Univariate and multivariate analyses were performed to determine the association between the sociodemographics and disease characteristics of RA with thickened CIMT.

Results. Abnormally thickened CIMT were observed in 11 RA patients (27.5%) and in 4 control subjects (10%), p = 0.04. It was highly prevalent among RA patients with active disease (54.5% vs 17.2%), p = 0.02. Patients with thickened CIMT also tend to have erosive disease, p = 0.06. Seropositive rheumatoid factor (RF) patients also had significantly higher CIMT values as compared with sero-negative patients, p = 0.03. Multivariable logistic regression analysis revealed that active disease was independently associated with thickened CIMT.

Conclusions. RA patients are at risk for subclinical atherosclerosis despite absence of traditional CV risk co morbidities and active disease was the independent factor associated with it.     

Cardiac evaluation for non-cardiac surgical patients

There is no evidence that most of the clinical examinations we prescribe before any surgical operation may be useful to a prognostic evaluation of the patient. Recently, some authors showed that there was no postoperative difference between 2 groups of patients. The 1(st) group had performed many laboratory examinations, the 2(nd) group none at all. Both the surgical operations and the characteristics of the patients may foresee a high, intermediate or low risk. The major clinical complications may be foreseen through tested algorithms. Patients who are at risk of cardiac events should perform tests which may be invasive but may reveal a serious heart disease. In some cases, the patients should have to be submitted to heart surgery before their programmed intervention.     

Poor control and management of cardiovascular risk factors among Albanian diabetic adult patients

BACKGROUND: Cardiovascular and metabolic risk factors represent potential targets for intervention. A good metabolic control, associated with control of blood pressure and cholesterol levels is proven to reduce the risk of cardiovascular disease among individuals with diabetes mellitus. OBJECTIVES: To examine 2004-2005 medical records of adults with previously diagnosed diabetes and to evaluate the fulfillment of diabetes guidelines treatment, for the metabolic control and management of cardiovascular risk factors. RESEARCH, DESIGN AND METHODS: We reviewed the data from the National Register of Diabetes (Tirana district), updated during this period. As guidelines we used the ADA 2006 Recommendations for metabolic control, HTA, lipid profile and aspirin therapy. RESULTS: We examined 7259 medical records. Only 14.58% of the patients had an HbA1c <7%. Central obesity was present in 39% of our patients. Overall, only 31.9% of our patients achieved the target for blood pressure (SBP<130 mmHg and DBP<80 mmHg). Two-third of our patients had total cholesterol >200 mg/dl. In total, only 5.5% of our patients attained recommended goals of cardiovascular risk factors for HbA1c, blood pressure and lipid profile. CONCLUSIONS: The follow-up of diabetic patients during the transient period in Albania is marked by a deterioration of diabetes metabolic control and poor management of cardiovascular risk factors. Further public health efforts are needed for better control of these risk factors among adults with diagnosed diabetes.     

106例血液透析患者心血管疾病的危险因素分析

目的探讨血液透析患者心血管疾病的危险因素。方法常规检测106例维持性血液透析患者的血脂、血清白蛋白(ALB)、尿素清除指数(KT/V)、尿酸、血磷及血压水平,并分析上述因素与血液透析患者心血管疾病之间的关系。结果血液透析患者心血管疾病为25%,其中缺血性心脏病6例,心功能不全5例,心脏增大21例,脑血管意外3例。伴心血管疾病的血液透析患者血清甘油三酯(TG)水平、年龄、透析前血清肌酐、尿酸、白蛋白、伴有高血压和心血管病变家族史的比例显著高于无心血管疾病患者,KT/V、透析时体外循环血量和超滤量显著低于后者。逐步条件logistic回归分析结果显示,年龄、高血压、TG、血磷、ALB是心血管疾病的重要危险因素,回归方程为P/(1-P)=exp(-12.81 0.239年龄 0.288高血压 1.586TG 4.270血磷-0.439ALB)。结论高血压、高龄、血清甘油三酯水平和血磷水平增高、血清白蛋白水平降低是血液透析患者心血管疾病的危险因素,血液透析不充分、透析时的体外血循环量及心血管家族史也与心血管疾病的发生有关。     

Pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery

More than 230 million surgical operations are performed yearly in the world and this number is continually growing. Thirty days mortality in moderate and high risk non-cardiac surgery is about 2% and exceeds 5% in patients with high cardiac risk. European Society of Cardiology (ESC) issued specific guidelines in 2009. ESC experts created clear stepwise algorithm for assessment of risk of cardiac complications in preoperative period and use of diagnostic and curative procedures aimed at its lowering. This allows to avoid unjustified investigations and drug therapy in operations with low cardiac risk and stresses significance of perioperative medical treatment. This review contains an analysis questioning some statements of the novel ESC guidelines such as reduction of preoperative cardiac tests and prophylactic revascularization of coronary arteries before operations with intermediate and high risk of cardiac complications.     

Metabolic profile and cardiovascular risk factors among Latin American HIV-infected patients receiving HAART

ObjectiveDetermine the prevalence of metabolic abnormalities (MA) and estimate the 10-year risk for cardiovascular disease (CVD) among Latin American HIV-infected patients receiving highly active anti-retroviral therapy (HAART).MethodsA cohort study to evaluate MA and treatment practices to reduce CVD has been conducted in seven Latin American countries. Adult HIV-infected patients with at least one month of HAART were enrolled. Baseline data are presented in this analysis.ResultsA total of 4,010 patients were enrolled. Mean age (SD) was 41.9 (10) years; median duration of HAART was 35 (IQR: 10-51) months, 44% received protease inhibitors. The prevalence of dyslipidemia and metabolic syndrome was 80.2% and 20.2%, respectively. The overall 10-year risk of CVD, as measured by the Framingham risk score (FRF), was 10.4 (24.7). Longer exposure to HAART was documented in patients with dyslipidemia, metabolic syndrome and type 2 diabetes mellitus. The FRF score increased with duration of HAART. Male patients had more dyslipidemia, high blood pressure, smoking habit and higher 10-year CVD than females.ConclusionsTraditional risk factors for CVD are prevalent in this setting leading to intermediate 10-year risk of CVD. Modification of these risk factors through education and intervention programs are needed to reduce CVD.     

心血管疾病护理中不安全因素分析

本文将2010年6月-2012年6月来我院进行治疗的心血管患者198例作为研究对象,分析护理过程中存在的不安全因素,进而提出相关的改进措施。采取问卷调查的方式,本文对其中的不安全因素进行了归纳总结,得出心血管科的护理人员应该对护理过程中所存在的这些不安全因素给予足够的重视,通过自身护理水平的不断提高来减少医惠之间的纠纷,进而提高医院的整体服务质量。