Intraoperative Management For Non-cardiac Surgery

We invaestigated the relationship between Intraoperative management and the incidence of perioperative cardiovascular events(PCE) in the patients with clinocal risk factors undergoing noncardiac surgery.about 147 cases were investigated.[methods]147 patients who with clinocal risk factors(history of ischemic heart disease;history of compensated or prior HF;history of cerebrovascular disease;diabetes mellitus DM and renal insufficiency) undergoing noncardiac surgery,were collected from April in 2008 to January 2009.All patients had randomly separated into two groups,the experiment group(do not intervene during operation)which include 70patients and the target group(Intraoperative Management according to the flow chart-1) which include 77 patients.Self-designed raw data sheets for enrolled patients had been used,which recorded every patients general information,including sex,age,weight,height,patient history of cardiovascular and cerebrovascular diseases,preoperative laboratory examination results(Holter monitoring),types of surgery,methods of anesthesia, operation time,volume of blood loss,hemodynamic changes,vital signs and administration during operation.At the same time,dynamic electrocardiogram was monitored continuously by 24-hour Holter recording devices from the begining of operation to 48 hours.Then vital signs,blood routine examination,electrolytes,blood biochemistry examination were recorded 24h and 48h post operation while their occurrences of cardiovascular events were monitored in hospital,and test the CTnI if it is necessary.The occurrence matter of perioperative cardiovascular events in two groups was observed in 147 patients in hospital and folloe-up after operation for 30 days in order that its rate was obtained,compare the incidence of PCM in each group of patients.[Results](1) 36 patients in both groups were suffered from cardiovascular events in hospital whose total rate was 24.5%.7 patients in the target group were suffered from cardiovascular events in hospital,whose total rate was 9.1%;29 patients in the experiment group were suffered from cardiovascular events in hospital,whose total rate was 41.1%.Compared with the experiment group the control group had less rate of PCE(9.1%vs 41.1%,P＜0.05).(2) In all of the PCM silent myocardial ischemia SMI was 17 case(3 case in target group vs 14 case in experiment group);more thanⅣventricular premature beat(VPB) of Lown's grade level was 13 case(2 case in target group vs 11 case in experiment group);Atrial fibrillation with uncontrolled ventricular rate[HR rate＞100 bpm]was 7 case (all of the 7 case in the experiment group);MobitzⅡatrioventricular heart block was 4 case(1 case in target group vs 3 case in experiment group);Myocardial infraction MI [the result of CtnI tests were positive]was 2 case(both of the 2 case in the experiment group);postoperative death was 2 case(both of the 2 case in the experiment group.[Conclusion](1) The incidence of perioperative cardiovascular events PCM in patients with clinocal risk factors is serious 36 patients in both groups were suffered from cardiovascular events in hospital whose total rate was 24.5%(2) The hightest incidence of perioperative cardiovascular events was myocardial ischemia,which occupied 47%,of total and the most of which were silent myocardial ischemia SMI,(3)For patients with clinocal risk actors undergoing noncardiac surgery.Quality Intraoperative management during operation may contribute to decrease the incidence of PCM.