心脏病人非心脏手术课件.ppt
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- 心脏 病人 手术 课件
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1、心脏病人非心脏手术指南2014 ACC/AHA Guideline术中麻醉管理部分麻醉药物和麻醉技术麻醉药物和麻醉技术l Class IIa 1.Use of either a volatile anesthetic agent or total intravenous anesthesia is reasonable for patients undergoing noncardiac surgery,and the choice is determined by factors other than the prevention of myocardial ischemia and MI(
2、Level of Evidence:A)Landoni G,Fochi O,Bignami E,et al.Cardiac protection by volatile anesthetics in non-cardiac surgery?A metaanalysis of randomized controlled studies on clinically relevant endpoints.HSR Proc Intensive Care Cardiovasc Anesth.2009;1:34-43.Lurati Buse GAL,Schumacher P,Seeberger E,et
3、al.Randomized comparison of sevoflurane versus propofol to reduce perioperative myocardial ischemia in patients undergoing noncardiac surgery.Circulation.2012;126:2696-704.文献汇报文献汇报l文献1l 2768 to TIVA and 3451 receiving desflurane or sevoflurane in their anesthesia planl Volatile anesthetic dosage var
4、ied across studies,ranging 0.33-2 MAC in the 609 patients receiving desflurane and 0.25-2 MAC in the 2842 patients receiving sevofluranel Hospital stay was identical between groups(WMD 0.01 days-0.06,0.07,p for effect=0.88,p for heterogeneity=0.48,I2=0%with 1201 included patientsl No author reported
5、 any postoperative myocardial infarction or death among the study population,nor any significant cardiac adverse eventl Postoperative renal or respiratory failure and release of cardiac biomarkers were not reported心律失常l文献2l 在心脏手术中22 included trials included 1,922 randomly assigned patients(904 to TI
6、VA and 1018 receiving desflurane or sevoflurane in their anesthesia plan)Volatile anesthetic dosage varied across the studies,but was always 0.15 MAC and ranged from 0.15-2 MAC in the 475 patients receiving desflurane and 0.25-4 MAC in the 543 patients receiving sevoflurane MINERVA ANESTESIOL 2009;7
7、5:269-73 volatile anesthetics reduced the risk of MI(24/979 2.4%in the volatile anesthetics group vs.45/874 5.1%in controls,OR=0.510.32-0.84,P for effect=0.008),all-cause mortality was also reduced(4/977 0.4%vs.14/872 1.6%,OR=0.31 0.12-0.80,P for effect-0.02 a significant decrease in cTnI peak relea
8、se(WMD-2.35 ng/dl-3.09,-1.60,P for effect 0.00001,P for heterogeneity 0.00001,I2=94.1%with 1,463 included patients)and the need for inotropic support(170/679 25.0%vs.203/562 36.1%,OR=0.47 0.29,0.76,P for effect 0.002,P for heterogeneity=0.008,I2=53.1%with 1,241 included patients).a shorter ICU stay(
9、WMD=-7.10 hours-11.47;-2.73,P for effect0.001,P for heterogeneity 0.00001,I2=76.6%with 1,433 included patients),time to hospital discharge(WMD=-2.26 days-3.83;-0.68,P for effect=0.005,with 1,593 included patients)time on mechanical ventilation(WMD=-0.49 hours-0.97;-0.02,P for effect=0.04,p for heter
10、ogeneity 0.03,I2=44.1%with 1,846 included patients).Finally,only two studies reported one year follow-up data concerning major cardiac events(defined as cardiac death,non-fatal MI,unstable angina,intercurrent coronary angioplasty,CABG,arrhythmias requiring hospitalization and new episodes of congest
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