Kalp Dışı Cerrahi Planlanan Hastalarda Preoperatif Kardiyak Değerlendirme Yöntemlerimizin Etkinliği

Öz

Amaç: Toplumdaki yaş ortalamasının yükselmesi ile kardiyak hasta sayısı giderek artmaktadır. Buna bağlı olarak kalp dışı cerrahi geçirecek hastalarda kardiyak komplikasyonlar daha sık görülmektedir. Bu nedenle kardiyak riski olan hastaların preoperatif dönemde öngörülmesinin; hastaların tedavilerinin planlanmasının ve operasyon sırasında gerekli önlemlerin alınabilmesinin önemi daha da artmıştır.Gereç ve Yöntemler: 1 Ağustos - 1 Kasım 2011 tarihleri arasında Anestezi Polikliniğine başvuran ve kalp dışı operasyon geçirecek hastalar çalışmaya alınmıştır. Hastalar “Kalp Dışı Cerrahide Preoperatif Değerlendirme Formu” ile preoperatif olarak değerlendirilmiş ve “Kalp Dışı Cerrahide Kardiyak Hastaların Takip Formu” ile takip edilmişlerdir. “Kardiyak Risk Değerlendirme ve Tanı Algoritması” ve “Klinik Risk Faktörleri”ne göre riskli olan hastalarımız Kardiyoloji Anabilim Dalı tarafından konsülte edilmişlerdir. Bulgular: Çalışmaya alınan 1113 hastamızın 119’un da %10,7 kardiyoloji kliniği değerlendirilmesi yapılmıştır. Kardiyoloji değerlendirmesi yapılan hastalarımızda yaş grupları arasında istatistiksel fark görülmüştür p=0,01 . En sık görülen unstabil kardiyak durum %77,1 ile aritmilerdir. ß-bloker kardiyoloji tarafından en çok önerilen ilaç grubu olmuştur. Üç hastada anestezi indüksiyonunda hipotansiyon, 2 hastada intraoperatif aritmi izlenmiştir. Bu hastalar kardiyolojik değerlendirilmesi yapılan ve tedavileri planlanan hastalardır.Sonuç: Yapılan preoperatif değerlendirme yöntemleri ile intraoperatif dönemde kardiyak risk grubu olarak öngörülmüş hastalarda az da olsa kardiyak komplikasyon meydana gelmesi; ve tedavi edilebilmiş olması çalışmamızın protokolünün kalp dışı cerrahi uygulanan hastaların preoperatif değerlendirilmeleri için etkin olduğunu göstermiştir

Anahtar Kelimeler

• Kalp dışı cerrahi, Preoperatif değerlendirme, Kardiyak riskli hasta

Effectiveness of Preoperative Cardiac Assessment Methods in Patients With Non-Heart Surgery

Abstract

Objective: The number of cardiac patients is increasing with the increased mean age of the population. Cardiac complications are also now being seen more frequently in patients undergoing non-cardiac surgery. Preoperative evaluation of patients with cardiac risk, planning the treatment of patients and taking necessary precautions during the operation have therefore become more important.Material and Methods: Patients who presented at the anesthesia outpatients between 1 August and 1 November 2011 and were scheduled to undergo non-cardiac surgery were included in the study. The patients were assessed preoperatively with the "Non-cardiac Surgery Preoperative Evaluation Form" and followed-up with the "Follow-up Form for Cardiac Patients after Non-cardiac Surgery". The patients found to be at risk with the "Cardiac Risk Assessment and Diagnostic Algorithm "and the "Clinical Risk Factors" were consulted to the Department of Cardiology.Results: A total of 1113 patients were enrolled in the study and 119 10.7% were evaluated by the cardiology department. There was a statistical difference between the age groups in the patients undergoing cardiology evaluation p=0.01 . The most common conditions were unstable cardiac arrhythmias at 77.1%. ß-blockers were the most commonly recommended drug group by the cardiology department. Three patients had hypotension during anesthesia induction and 2 patients had intraoperative arrhythmia. These patients had undergone a cardiology evaluation and the treatment planned accordingly.Conclusion: The fact that only a small number of cardiac complications occurred in the intraoperative period in patients who were judged to have cardiac risk with preoperative evaluation methods showed that the protocol of our study was effective for preoperative evaluation of non-cardiac surgery patients

Keywords

• Non-cardiac surgery, Preoperative evaluation, Cardiac risk patient

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