术前评估量表对非心脏手术患者围手术期主要心脏不良事件的预测价值Predictive Value of Preoperative Assessment Tools for Perioperative Major Adverse Cardiac Event in Patients Undergoing Noncardiac Surgery
许广艳;许力;刘子嘉;黄宇光;
XU Guang-yan;XU Li;LIU Zi-jia;HUANG Yu-guang;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;
摘要(Abstract):
非心脏手术患者围手术期主要心脏不良事件是其并发症和病死率增加的重要原因,术前应用恰当的评估量表进行风险评估至关重要,临床已达成共识并进行广泛实践。修订的心脏风险指数、美国外科医师协会国家外科质量改进计划心肌梗死或心脏骤停风险计算器和美国外科医师协会国家外科质量改进计划手术风险计算器是目前临床常用的评估量表。目前尚缺乏相关研究分析上述评估量表的适用条件和优缺点,以及何种评估量表能较为准确地预测非心脏手术患者围手术期主要心脏不良事件风险。本文总结上述评估量表在非心脏手术患者中的应用表现,旨在为这一人群寻找最优化的评估量表提供指导。
The major adverse cardiac event( MACE) in patients undergoing noncardiac surgery is associated with a marked increase in morbidity and mortality. It is critical to use appropriate assessment tools preoperatively to assess the risk of major adverse cardiac event in patients undergoing noncardiac surgery. We already have guidelines and expert consensus to guide the risk stratification for perioperative major adverse cardiac events in patients undergoing noncardiac surgery. Revised Cardiac Risk Index,the American College of Surgeons' National Surgical Quality Improvement Program Myocardial Infarction or Cardiac Arrest Risk Calculator,and the American College of Surgeons' National Surgical Quality Improvement Program Surgical Risk Calculator are currently common assessment tools used for perioperative major adverse cardiac events in patients undergoing noncardiac surgery. Currently,we have no relevant research on analyzing the applicable conditions,evaluating the merits and demerits of those assessment tools,and comparing the predictive values on perioperative major adverse cardiac events in patients undergoing noncardiac surgery. In this article,we review some domestic and foreign literature in recent years,attempting to summarize the performance of these assessment tools in patients undergoing noncardiac surgery. We also aim to provide a guide for doctors to find the most optimal preoperative assessment tool.
关键词(KeyWords):
手术;围手术期;风险评估量表
surgery;perioperative period;risk assessment tools
基金项目(Foundation):
作者(Author):
许广艳;许力;刘子嘉;黄宇光;
XU Guang-yan;XU Li;LIU Zi-jia;HUANG Yu-guang;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;
Email:
DOI:
参考文献(References):
- [1] Weiser TG,Haynes AB,Molina G,et al. Estimate of the global volume of surgery in 2012:an assessment supporting improved health outcomes[J]. Lancet,2015,385:S11.
- [2] Weiser TG,Regenbogen SE,Thompson KD,et al. An estimation of the global volume of surgery:a modelling strategy based on available data[J]. Lancet,2008,372:139-144.
- [3] Devereaux PJ,Sessler DI. Cardiac Complications in Patients Undergoing Major Noncardiac Surgery[J]. N Engl J Med,2015,373:2258-2269.
- [4] Roshanov PS,Walsh M,Devereaux PJ,et al. External validation of the revised cardiac risk index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery:rationale and plan for analyzes of the VISION study[J]. BMJ Open, 2017,7:e013510.
- [5] Botto F,Alonso-Coello P,Chan MT,et al. Myocardial injury after noncardiac surgery:a large,international,prospective cohort study establishing diagnostic criteria,characteristics,predictors,and 30-day outcomes[J]. Anesthesiology,2014,120:564-578.
- [6] Pannell LM,Reyes EM,Underwood SR. Cardiac risk assessment before non-cardiac surgery[J]. Eur Heart J Cardiovasc Imaging,2013,14:316-322.
- [7] Udeh BL,Dalton JE,Hata JS,et al. Economic trends from2003 to 2010 for perioperative myocardial infarction:a retrospective,cohort study[J]. Anesthesiology,2014,121:36-45.
- [8] Fleisher LA,Fleischmann KE,Auerbach AD,et al. 2014ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. Circulation,2014,130:2215-2245.
- [9] Kristensen SD,Knuuti J,Saraste A,et al. 2014 ESC/ESA Guidelines on non-cardiac surgery:cardiovascular assessment and management:The Joint Task Force on noncardiac surgery:cardiovascular assessment and management of the European Society of Cardiology(ESC)and the European Society of Anaesthesiology(ESA)[J]. Eur Heart J,2014,35:2383-2431.
- [10] Duceppe E,Parlow J,Macdonald P,et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery[J]. Can J Cardiol,2017,33:17-32.
- [11]中华医学会麻醉学分会编.中国麻醉学指南与专家共识[M].北京:人民卫生出版社,2017:75-87.
- [12] Lee TH,Marcantonio ER,Mangione CM,et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery[J]. Circulation,1999,100:1043-1049.
- [13] Devereaux PJ,Yang H,Yusuf S,et al. Effects of extendedrelease metoprolol succinate in patients undergoing non-cardiac surgery(POISE trial):a randomised controlled trial[J]. Lancet,2008,371:1839-1847.
- [14] Hoftman N,Prunean A,Dhillon A,et al. Revised Cardiac Risk Index(RCRI)is a useful tool for evaluation of perioperative cardiac morbidity in kidney transplant recipients[J].Transplantation,2013,96:639-643.
- [15] Ford MK, Beattie WS, Wijeysundera DN. Systematic review:prediction of perioperative cardiac complications and mortality by the revised cardiac risk index[J]. Ann Intern Med,2010,152:26-35.
- [16] Wotton R,Marshall A,Kerr A,et al. Does the revised cardiac risk index predict cardiac complications following elective lung resection?[J]. Cardiothora Surg,2013,8:220-220.
- [17] Smeili LAA,Lotufo PA. Incidence and Predictors of Cardiovascular Complications and Death after Vascular Surgery[J]. Arq Bras De Cardiol,2015,105:510-518.
- [18] Payne CJ,Bryce GJ,Gibson SC,et al. The Revised Cardiac Risk Index performs poorly in patients undergoing major vascular surgery:a prospective observational study[J]. Eur J Anaesthesiol,2013,30:713-715.
- [19] Devereaux PJ,Chan MTV,Walsh M,et al. An international prospective cohort study evaluating major vascular complications among patients undergoing noncardiac surgery:the VISION Pilot Study[J]. Open Med,2011,5:e193-e200.
- [20] Che L,Xu L,Huang Y,et al. Clinical utility of the revised cardiac risk index in older Chinese patients with known coronary artery disease[J]. Clin Interv Aging, 2017, 13:35-41.
- [21] Biccard B. Proposed research plan for the derivation of a new Cardiac Risk Index[J]. Anesth Analg, 2015, 120:543-553.
- [22] Davis C,Tait G,Carroll J,et al. The Revised Cardiac Risk Index in the new millennium:a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients[J]. Can J Anesth,2013,60:855-863.
- [23] Gupta PK,Gupta H,Sundaram A,et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery[J]. Circulation,2011,124:381-387.
- [24] Peterson B,Ghahramani M,Harris S,et al. Usefulness of the Myocardial Infarction and Cardiac Arrest Calculator as a Discriminator of Adverse Cardiac Events After Elective Hip and Knee Surgery[J]. Am J Cardiol, 2016, 117:1992-1995.
- [25] Cohn SL,Ros NF. Comparison of 4 Cardiac Risk Calculators in Predicting Postoperative Cardiac Complications after Noncardiac Operations[J]. Am J Cardiol, 2018, 121:125-130.
- [26] Bilimoria KY,Liu Y,Paruch JL,et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator:a decision aid and informed consent tool for patients and surgeons[J]. Am Coll Surg,2013,217:833-842.
- [27] Cohen ME,Liu Y,Ko CY,et al. An Examination of American College of Surgeons NSQIP Surgical Risk Calculator Accuracy[J]. Am Coll of Surg,2017,224:787-795.
- [28] Kazaure HS,Roman SA,Rosenthal RA,et al. Cardiac arrest among surgical patients:an analysis of incidence,patient characteristics, and outcomes in ACS-NSQIP[J].JAMA Surg,2013,148:14-21.
- [29] Buschmann CT,Tsokos M. Frequent and rare complications of resuscitation attempts[J]. Intensive Care Med,2009,35:397-404.
- [30] Prasad KG,Nelson BG,Deig CR,et al. ACS NSQIP risk calculator:an accurate predictor of complications in major head and neck surgery?[J]. Otolaryngol Head Neck Surg,2016,155:740-742.
- [31] Schneider AL,Deig CR,Prasad KG,et al. Ability of the National Surgical Quality Improvement Program Risk Calculator to predict complications following total laryngectomy[J]. JAMA Otolaryngol Head Neck Surg,2016,142:972-979.
- [32] Arce K,Moore EJ,Lohse CM,et al. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator does not accurately predict risk of30-day complications among patients undergoing microvascular head and neck reconstruction[J]. Oral Maxillofac Surg,2016,74:1850-1858.
- [33] Teoh D,Halloway RN,Heim J,et al. Evaluation of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator in gynecologic oncology patients undergoing minimally invasive surgery[J].Minim Invasive Gynecol,2017,24:48-54.
- [34] Rivard C,Nahum R,Slagle E,et al. Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy[J].Gynecol Oncol,2016,141:281-286.
- [35] Szender JB,Frederick PJ,Eng KH,et al. Evaluation of the National Surgical Quality Improvement Program Universal Surgical Risk Calculator for a gynecologic oncology service[J]. Int Gynecol Cancer,2015,25:512-520.
- [36] O'Neill AC, Bagher S, Barandun M, et al. Can the American College of Surgeons NSQIP surgical risk calculator identify patients at risk of complications following microsurgical breast reconstruction?[J]. Plast Reconstr Aesthet Surg,2016,69:1356-1362.
- [37] Liu Y,Cohen ME,Hall BL,et al. Evaluation and enhancement of calibration in the American College of Surgeons NSQIP Surgical Risk Calculator[J]. Am Coll Surg,2016,223:231-239.
- [38] Greenhalgh RM,Brown LC,Powell JT,et al. Endovascular versus open repair of abdominal aortic aneurysm[J]. N Engl Med,2010,362:1863-1871.
- [39] Rodseth RN,Lurati Buse GA,Bolliger D,et al. The predictive ability of pre-operative B-type natriuretic peptide in vascular patients for major adverse cardiac events:an individual patient data meta-analysis[J]. Am Coll Cardiol,2011,58:522-529.
- [40] Devereaux PJ,Chan MT,Alonso-Coello P,et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery[J].JAMA,2012,307:2295-2304.
- 许广艳
- 许力
- 刘子嘉
- 黄宇光
XU Guang-yan- XU Li
- LIU Zi-jia
- HUANG Yu-guang
- Department of Anesthesiology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- 许广艳
- 许力
- 刘子嘉
- 黄宇光
XU Guang-yan- XU Li
- LIU Zi-jia
- HUANG Yu-guang
- Department of Anesthesiology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College