如何在非心脏手术之前、期间和之后管理心脏和中风风险

For people having surgery unrelated to their hearts, new guidelines detail how to manage heart and stroke risks before, during and after surgery.

The guidelines, based on evidence accumulated over the past decade, 解决诸如如何减少测试以避免不必要的成本和手术延误以及如何正确管理血压和心脏药物等问题. 美国心脏协会和美国心脏病学会周二发布了这份报告. Seven other medical societies endorsed the new guidelines.

“关于如何最好地评估和管理非心脏手术患者围手术期心血管风险，有大量的新证据," Dr. Annemarie Thompson, who led the guidelines writing group, said in a news release. Thompson is a professor of anesthesiology, 杜伦杜克大学医学院的医学和人口健康科学, North Carolina.

"Worldwide, there are approximately 300 million noncardiac surgeries each year, 哪一点强调了总结和解释证据以帮助临床医生管理前来手术的患者的必要性," she said.

The updated guidelines, which target health professionals across disciplines, 从术前评估到术后护理都是为非心脏手术患者写的吗. 其中包括对冠状动脉疾病患者的建议, hypertrophic cardiomyopathy, heart valve disease, pulmonary hypertension, obstructive sleep apnea and previous stroke. They replace older guidelines published in 2014.

"The U.S. 人口老龄化，慢性疾病患者寿命延长, including chronic heart and vascular diseases," Thompson said. "A multidisciplinary, team-based approach" that includes surgeons, 需要初级保健医生和专家来确保对患有心血管疾病和危险因素的人进行最佳护理, during and after surgery, she said.

新的指南涵盖了心血管检测和筛查的使用, 患者评估和评估以及如何管理需要全身或区域麻醉的手术患者心血管疾病的最新证据.

他们还建议人们采取新的治疗方法来控制糖尿病, heart failure and obesity. Specifically, 指南建议术前3 - 4天停用钠-葡萄糖共转运蛋白-2 (SGLT2)抑制剂，以尽量减少并发症的风险. 该指南还包括停止和恢复使用血液稀释剂的建议.

"From prior studies, conditions such as high blood pressure, Type 2 diabetes, age older than 55 in men and 65 in women, 吸烟和肥胖是已知的使患者易患心血管疾病的危险因素," Thompson said. "Others have a family history of premature coronary artery disease, which can also put them at increased risk. 这些指南的编写是基于这样一种理解，即这些和其他心血管危险因素和条件如果在手术前未被识别或未被优化，可能会导致不良的手术结果."

更新后的指南还强调需要在两个领域进行进一步研究.

一种是新发现的非心脏手术后心肌损伤, or MINS, 哪一种是在手术期间或手术后不久发生的心脏损伤. 人们对什么原因导致MINS或如何预防或管理它知之甚少.

还需要更多的研究来了解如何处理可能在非心脏手术期间或之后发生的不规则心律, which can increase the risk for stroke.