心臟病患進行非心臟手術期間的追蹤研究－－兩所醫學中心共同研究

A Two-Center Survey of Cardiac Events and Peri-operative Managements of Cardiac Patients Undergoing Non-cardiac Surgery in Taiwanese Population

背景：心臟病患進行非心臟手術之危險性相當高，成功之術前準備及術中麻醉處理有賴醫療團隊細心之合作及與病人良好溝通。文獻上相關此類手術之危險因子主要乃根據歐美人口做出分析，本研究主要探討台灣地區心臟病患進行非心臟手術之危險因子及術前準備、術中及術後處理概況。方法：兩所臺灣醫學中心共同參予設定一前瞻性問卷，對接受非心臟手術之心臟病人其術前評估、術中事故、術後加護病房照護等做一探討。結果：自2002年3月至2002年5月兩所醫學中心共自10129件手術案例中篩選了196案例進入問卷研究，而此類病患之危險因子包括：冠心症、高血壓、糖尿病、鬱血性心臟病、心律不整、腎功能不全。196案例中只有26.5％(52)及16.8％(33)分別有作心臟科及麻醉科之會診，術前特種心臟功能檢查只有34人次而已。而亦只有20.9％(41)之病人於術後接受加護病房之照護。196案例中有兩例發生手術期間死亡，14例手術期間發生併發症。結論：臺灣地區高危險心臟病患進行非心臟手術在術前評估準備及術後加護照顧仍有很大之改善空間。

Background: The risk of cardiac patients undergoing noncardiac surgery is relatively high. Successful preoperative evaluation and perioperative anesthetic management of a patient require a good communication among the patient, the anesthesiologist and the surgeon as well as excellent cooperation between the surgeon and anesthesiologist with a tacit understanding of the peri-operative risks. Peri-operative risk factors have been readily investigated in Caucasians or Westerners. As different ethnic populations may have different risk factors for a same disease entity, understanding the uniqueness in this respect in Taiwanese is mandatory. The purpose of this study is to examine the risk factors, perioperative cardiac events and the qualities of preoperative preparation and postoperative intensive care in Taiwanese cardiac patients undergoing noncardiac surgery. Methods: Two medical centers in Taiwan worked out a set of prospective questionnaire to evaluate the preoperative preparation, intraoperative events, and postoperative care of cardiac patients undergoing noncardiac surgery in these hospitals. Results: Between March 2002 and May 2002, there were 196 cardiac patients undergoing noncardiac surgery out of a total of 10,129 anesthetized surgical patients in two medical centers. The risk factors of these patients included coronary artery disease, hypertension, diabetes mellitus, congestive heart failure, arrhythmia, and renal function impairment. In these 196 cases, only 26.5% (52) and 16.8% (33) had been preoperatively evaluated by cardiologist and anesthesiologist respectively through consultation. The number of pre-operation specific cardiac tests totaled 34, and 41 patients (20.9%) required post-operative intensive care. There were two peri-operative fatalities and fourteen peri-operative cardiac events. Conclusions: The quality of care for preoperative evaluation and quality assurance need to be improved in Taiwan.