Functional status assessment for preoperative cardiac risk prediction.
Functional status assessment for preoperative cardiac risk prediction.
复制标题
术前心脏风险预测的功能状态评估。
DOI：
10.1097/aia.0000000000000305
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发表时间：
2021
影响因子：
0.6
通讯作者：
Rubin,DanielS
中科院分区：
文献类型：
--
作者：
Rubin,DanielS
自 1941 年美国麻醉医师协会身体状态分类系统 (ASA PS) 诞生以来，功能能力评估在围手术期风险评估中发挥着重要作用。1 ASA PS 的最初目的是创建患者合并症负担的综合衡量标准，并重点关注患者的病情，而不是与手术程序本身相关的风险（即“手术风险”）。 ASA PS 包括对功能能力的估计，以帮助识别高风险患者，以及与较高 ASA PS 等级相关的功能能力较差的患者。随后对有或没有功能能力评估的 ASA PS 进行的评估表明，在 ASA PS 中添加功能能力可以改善围手术期死亡率的预测。 2专门用于心脏风险预测的功能能力评估出现在 1996 年美国心脏病学会和美国心脏协会 (ACC/AHA) 第一版非心脏手术围手术期心血管评估实践指南中。3 功能能力评估的增加是基于其预测未来心血管事件的能力。特别是，使用功能能力的基本原理依赖于 1984 年的一项研究，该研究在冠状动脉手术研究 (CASS) 中确定了心血管疾病患者的死亡风险。 4 在跑步机运动测试中无法达到 5 代谢当量 (MET) 的布鲁斯 I 期患者，且相关 ST 段压低≥ 1 毫米，随后的年死亡率为 5%。相反，能够运动至 Bruce 3 级或以上且 ST 段压低 < 1 毫米的患者的年死亡率 < 1%。其他研究也发现了类似的结果，支持功能能力差与随后的心血管死亡率之间的关联。 5, 6 Bruce 跑步机锻炼方案的第一阶段涉及以 1.7 英里/小时（2.74 公里/小时）的速度在 10% 的坡度上行走。 Bruce I 阶段步行能量消耗的估计 MET 值约为 4.6 MET，这就是为什么将 < 4 MET 阈值确定为功能能力差的临界值。 7
Functional capacity assessment has played an important role in perioperative risk assessment since the inception of the American Society of Anesthesiologists Physical State classification system (ASA PS) in 1941. 1 The original intent of the ASA PS was to create a composite measure of the patient’s comorbidity burden and focus on the patient’s condition rather than the risk associated with the surgical procedure itself, known as “operative risk.” The ASA PS included an estimate of functional capacity to assist in identifying patients who would be high risk, with patients with poor functional capacity associated with a higher ASA PS class. Subsequent evaluations of ASA PS with and without a functional capacity evaluation have demonstrated that the addition of functional capacity to ASA PS improves the prediction of perioperative mortality. 2Functional capacity assessment specifically for cardiac risk prediction appeared in the first version of the American College of Cardiology and American Heart Association (ACC/AHA) practice guidelines for the perioperative cardiovascular evaluation for noncardiac surgery in 1996. 3 The addition of functional capacity assessment was based on its ability to predict future cardiovascular events. In particular, the rationale for using functional capacity relied on a study from 1984 that identified mortality risk for patients with cardiovascular disease in the Coronary Artery Surgery Study (CASS). 4 Patients unable to achieve 5 metabolic equivalents (METs), Bruce stage I, on a treadmill exercise test with associated ST-segment depression≥ 1 mm had a subsequent 5% yearly mortality. Conversely, patients who were able to exercise into Bruce stage 3 or greater and had ST-segment depressions< 1 mm had an annual mortality< 1%. Similar results have been found in other studies, which supports the association between a poor functional capacity and subsequent cardiovascular mortality. 5, 6 Stage I of the Bruce exercise treadmill protocol involves walking at a speed of 1.7 mph (2.74 km/h) on a gradient of 10%. The estimated MET value for the energy cost of walking at a Bruce stage I is roughly 4.6 METs, which is how the< 4 MET threshold became established as a cutoff for poor functional capacity. 7