Perioperative Myocardial Injury/Infarction After Non-cardiac Surgery in Elderly Patients.
Perioperative Myocardial Injury/Infarction After Non-cardiac Surgery in Elderly Patients.
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DOI：
10.3389/fcvm.2022.910879
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发表时间：
2022
影响因子：
3.6
通讯作者：
Cheng, Rui
中科院分区：
文献类型：
--
作者：
Gao, Linggen;Chen, Lei;He, Jing;Wang, Bin;Liu, Chaoyang;Wang, Rong;Fan, Li;Cheng, Rui
目前，我们已经进入老龄化社会。老年人患有的许多疾病，如恶性肿瘤、心血管疾病、骨折、外科急症等，都需要外科干预。随着老年医学、外科微创技术和麻醉水平的提高，越来越多的老年患者可以安全地进行手术。高龄手术患者常合并多种慢性疾病，术后心肌损伤/梗死（PMI）风险高。PMI被认为是围手术期缺血引起的心肌肌钙蛋白升高，多发生在手术期间或术后30天内，可增加短期和长期死亡的风险。因此，建议对老年患者围手术期进行肌钙蛋白筛查，及时发现术后心肌损伤患者并给予相应治疗，以改善预后。PMI的病理生理机制主要是心肌耗氧量增加和/或心肌氧供应减少。术前、术后氧供不匹配可诱发心肌损伤的术前、术后危险因素。治疗策略应首先控制危险因素，使用指南推荐的药物进行治疗。抗血小板β受体阻滞剂、他汀类药物、血管紧张素转换酶抑制剂等心血管药物的应用可有效改善术后心肌缺血。但在使用抗血小板和抗凝药物前应充分考虑围手术期出血的风险。本文综述了术后心肌梗死/损伤的流行病学、诊断、病理生理、危险因素、预后和治疗。
At present, we have entered an aging society. Many diseases suffered by the elderly, such as malignant tumors, cardiovascular diseases, fractures, surgical emergencies and so on, need surgical intervention. With the improvement of Geriatrics, surgical minimally invasive technology and anesthesia level, more and more elderly patients can safely undergo surgery. Elderly surgical patients are often complicated with a variety of chronic diseases, and the risk of postoperative myocardial injury/infarction (PMI) is high. PMI is considered to be the increase of cardiac troponin caused by perioperative ischemia, which mostly occurs during operation or within 30 days after operation, which can increase the risk of short-term and long-term death. Therefore, it is suggested to screen troponin in elderly patients during perioperative period, timely identify patients with postoperative myocardial injury and give appropriate treatment, so as to improve the prognosis. The pathophysiological mechanism of PMI is mainly due to the increase of myocardial oxygen consumption and / the decrease of myocardial oxygen supply. Preoperative and postoperative risk factors of myocardial injury can be induced by mismatch of preoperative and postoperative oxygen supply. The treatment strategy should first control the risk factors and use the drugs recommended in the guidelines for treatment. Application of cardiovascular drugs, such as antiplatelet β- Receptor blockers, statins and angiotensin converting enzyme inhibitors can effectively improve postoperative myocardial ischemia. However, the risk of perioperative bleeding should be fully considered before using antiplatelet and anticoagulant drugs. This review is intended to describe the epidemiology, diagnosis, pathophysiology, risk factors, prognosis and treatment of postoperative myocardial infarction /injury.
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影响因子：
9
作者：
Livhits, Masha;Ko, Clifford Y.;de Virgilio, Christian
通讯作者：
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影响因子：
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影响因子：
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