心脏病人非心脏手术培训课件.ppt
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- 心脏 病人 手术 培训 课件
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1、心脏病人非心脏手术心脏病人非心脏手术麻醉药物和麻醉技术麻醉药物和麻醉技术lClass IIa1.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(Level of Evidence:A)Lando
2、ni 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 al.Randomized comparison
3、of sevoflurane versus propofol to reduce perioperative myocardial ischemia in patients undergoing noncardiac surgery.Circulation.2012;126:2696-704.2心脏病人非心脏手术文献汇报文献汇报l文献13心脏病人非心脏手术l2768 to TIVA and 3451 receiving desflurane or sevoflurane in their anesthesia planlVolatile anesthetic dosage varied acr
4、oss studies,ranging 0.33-2 MAC in the 609 patients receiving desflurane and 0.25-2 MAC in the 2842 patients receiving sevofluranelHospital 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 any pos
5、toperative myocardial infarction or death among the study population,nor any significant cardiac adverse eventlPostoperative renal or respiratory failure and release of cardiac biomarkers were not reported4心脏病人非心脏手术心律失常5心脏病人非心脏手术l文献26心脏病人非心脏手术7心脏病人非心脏手术l在心脏手术中22 included trials included 1,922 random
6、ly assigned patients(904 to TIVA 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 sevoflu
7、rane MINERVA ANESTESIOL 2009;75:269-739心脏病人非心脏手术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-0.02a s
8、ignificant decrease in cTnI peak release(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
9、included patients).a shorter ICU stay(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.
10、97;-0.02,P for effect=0.04,p for heterogeneity 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 hospi
11、talization and new episodes of congestive heart failure10心脏病人非心脏手术Class IIa 2.Neuraxial anesthesia for postoperative pain relief can be effective in patients undergoing abdominal aortic surgery to decrease the incidence of perioperative MI(Level of Evidence:B)Nishimori M,Low JHS,Zheng H,et al.Epidur
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