Objective To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Un...Objective To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Union Medical College Hospital from January 1998 to August 2006 and identified 24 patients who subsequently underwent noncardiac surgery.Results There were no intraoperative cardiac events.Postoperative cardiac events were identified in 3 patients including 1 death due to acute myocardial infarction and 2 episodes of transient hypotension.Conclusions The risk of anesthesia and noncardiac surgery is low in patients with hypertrophic cardiomyopathy.During the perioperative period,beta-blockers and/or calcium channel blockers should be given;vasodilator and inotropic agents should be avoided due to the side effects on hemodynamics.展开更多
The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outc...The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outcomes.However,the recent studies have failed to provide evidence to support perioperative beta blockers,with potential increased mortality as showed in the POISE trial.In this paper,perioperative use of beta-blockers will be discussed,especially about the evolution of their perioperative therapeutic application and current status.展开更多
Background Few studies have investigated perioperative major adverse cardiac events （MACEs） in elderly Chinese patients with coronary heart disease （CHD） undergoing noncardiac surgery. This study examined the inci...Background Few studies have investigated perioperative major adverse cardiac events （MACEs） in elderly Chinese patients with coronary heart disease （CHD） undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system. Methods This retrospective observational clinical study included 482 patients aged -〉60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis. Results Perioperative MACE occurred in 61（12.66%） of the study patients. Five independent risk factors for perioperative MACE were identified： history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure 〈75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710＋0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk. Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.展开更多
Point-of-care transthoracic echocardiography （TTE） is an evolving field in anesthesia field and verified to have the potential to provide rapid diagnostic information during the hemodynamic collapse in operating roo...Point-of-care transthoracic echocardiography （TTE） is an evolving field in anesthesia field and verified to have the potential to provide rapid diagnostic information during the hemodynamic collapse in operating room.[1] In this retrospective observatory study, we retrieved all the data of 1-year consecutive use of intraoperative echocardiography in patients with circulatory collapse or undergoing selective high-risk noncardiac surgery.展开更多
BACKGROUND Takotsubo cardiomyopathy,also called apical ballooning syndrome,is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome.The aim of this article is t...BACKGROUND Takotsubo cardiomyopathy,also called apical ballooning syndrome,is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome.The aim of this article is to draw attention to takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst.CASE SUMMARY A 50-year-old diabetic and hypertensive female patient was evaluated preoperatively before general surgery for liver hydatid cyst,and no cardiac problems were found.The patient was discharged on the 3rd postoperative day without any postoperative complications.On postoperative day 5,the patient presented to the emergency department with fever,shortness of breath,chills,and shivering and was hospitalized with the diagnosis of pneumonia.The troponin levels remained high during follow-up.Echocardiography was performed on postoperative day 7,after which the patient was referred to a tertiary center with the diagnosis of non-ST-elevation myocardial infarction due to akinesia in the apical region.Coronary angiography performed at the tertiary center showed normal coronary anatomy,and the patient was diagnosed with takotsubo cardiomyopathy.CONCLUSION Takotsubo cardiomyopathy mimicking myocardial infarction without ST segment elevation may develop after surgical treatment of liver hydatid cyst.展开更多
目的探讨外科重症监护病房(surgical intensive care unit,SICU)内的非心脏手术患者围术期心血管事件与2年生存率的关系。方法回顾性分析北京大学第一医院2013年3月至2015年3月1753例因非心脏手术后入住SICU患者的病例资料。记录所有患...目的探讨外科重症监护病房(surgical intensive care unit,SICU)内的非心脏手术患者围术期心血管事件与2年生存率的关系。方法回顾性分析北京大学第一医院2013年3月至2015年3月1753例因非心脏手术后入住SICU患者的病例资料。记录所有患者的既往心血管病史,再收集术后重症病房住院期间新发心血管事件或既往心血管疾病加重的资料。所有患者转出重症医学科后予2年随访,统计分析其生存情况。结果截至转出重症医学科2年后,心血管病史组术后2年死亡率明显高于无心血管病史组(P=0.001),围术期出现心血管事件患者2年死亡率明显高于未出现围术期心血管事件患者(P<0.001)。多因素分析2年死亡率相关的独立危险因素包括既往冠状动脉粥样硬化性心脏病、围术期心力衰竭、围术期心肌缺血。结论非心脏手术SICU患者既往心血管病史及围术期心血管事件均会降低术后2年生存率,在治疗中应高度重视心血管疾病管理。展开更多
非心脏手术后心肌损伤(myocardial injury after noncardiac surgery,MINS)是非心脏手术术后的常见并发症,并与术后死亡率密切相关。大多数MINS患者无明显临床症状,易漏诊或误诊从而影响治疗,但MINS的结局与患者是否出现明显的临床症状...非心脏手术后心肌损伤(myocardial injury after noncardiac surgery,MINS)是非心脏手术术后的常见并发症,并与术后死亡率密切相关。大多数MINS患者无明显临床症状,易漏诊或误诊从而影响治疗,但MINS的结局与患者是否出现明显的临床症状或体征无关。因此,早期识别MINS的高危因素具有重要意义。大约40%的手术患者合并术前贫血,即使是轻度贫血也与各种术后并发症及非心脏手术后死亡率相关。术前贫血与MINS独立相关,MINS可能是术前贫血与术后30 d死亡率的桥梁因素。术后血红蛋白水平与心肌损伤之间也有很强的相关性。本文就围手术期血红蛋白水平与MINS关系的相关研究进行文献总结,为临床决策及后续研究提供参考。展开更多
文摘Objective To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Union Medical College Hospital from January 1998 to August 2006 and identified 24 patients who subsequently underwent noncardiac surgery.Results There were no intraoperative cardiac events.Postoperative cardiac events were identified in 3 patients including 1 death due to acute myocardial infarction and 2 episodes of transient hypotension.Conclusions The risk of anesthesia and noncardiac surgery is low in patients with hypertrophic cardiomyopathy.During the perioperative period,beta-blockers and/or calcium channel blockers should be given;vasodilator and inotropic agents should be avoided due to the side effects on hemodynamics.
文摘The best protocol of perioperative beta-blockers remains uncertain.Previous studies have demonstrated that tight heart rate control by beta-blockers reduced perioperative myocardial ischemia and improved clinical outcomes.However,the recent studies have failed to provide evidence to support perioperative beta blockers,with potential increased mortality as showed in the POISE trial.In this paper,perioperative use of beta-blockers will be discussed,especially about the evolution of their perioperative therapeutic application and current status.
文摘Background Few studies have investigated perioperative major adverse cardiac events （MACEs） in elderly Chinese patients with coronary heart disease （CHD） undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system. Methods This retrospective observational clinical study included 482 patients aged -〉60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis. Results Perioperative MACE occurred in 61（12.66%） of the study patients. Five independent risk factors for perioperative MACE were identified： history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure 〈75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710＋0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk. Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.
文摘Point-of-care transthoracic echocardiography （TTE） is an evolving field in anesthesia field and verified to have the potential to provide rapid diagnostic information during the hemodynamic collapse in operating room.[1] In this retrospective observatory study, we retrieved all the data of 1-year consecutive use of intraoperative echocardiography in patients with circulatory collapse or undergoing selective high-risk noncardiac surgery.
文摘BACKGROUND Takotsubo cardiomyopathy,also called apical ballooning syndrome,is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome.The aim of this article is to draw attention to takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst.CASE SUMMARY A 50-year-old diabetic and hypertensive female patient was evaluated preoperatively before general surgery for liver hydatid cyst,and no cardiac problems were found.The patient was discharged on the 3rd postoperative day without any postoperative complications.On postoperative day 5,the patient presented to the emergency department with fever,shortness of breath,chills,and shivering and was hospitalized with the diagnosis of pneumonia.The troponin levels remained high during follow-up.Echocardiography was performed on postoperative day 7,after which the patient was referred to a tertiary center with the diagnosis of non-ST-elevation myocardial infarction due to akinesia in the apical region.Coronary angiography performed at the tertiary center showed normal coronary anatomy,and the patient was diagnosed with takotsubo cardiomyopathy.CONCLUSION Takotsubo cardiomyopathy mimicking myocardial infarction without ST segment elevation may develop after surgical treatment of liver hydatid cyst.
文摘目的探讨外科重症监护病房(surgical intensive care unit,SICU)内的非心脏手术患者围术期心血管事件与2年生存率的关系。方法回顾性分析北京大学第一医院2013年3月至2015年3月1753例因非心脏手术后入住SICU患者的病例资料。记录所有患者的既往心血管病史,再收集术后重症病房住院期间新发心血管事件或既往心血管疾病加重的资料。所有患者转出重症医学科后予2年随访,统计分析其生存情况。结果截至转出重症医学科2年后,心血管病史组术后2年死亡率明显高于无心血管病史组(P=0.001),围术期出现心血管事件患者2年死亡率明显高于未出现围术期心血管事件患者(P<0.001)。多因素分析2年死亡率相关的独立危险因素包括既往冠状动脉粥样硬化性心脏病、围术期心力衰竭、围术期心肌缺血。结论非心脏手术SICU患者既往心血管病史及围术期心血管事件均会降低术后2年生存率,在治疗中应高度重视心血管疾病管理。
