班长许俊

CirculationJournalVol.67,Suppl.IV,20031175122-12-22-334512345678920012002Guidelinesforperioperativecardiovascularevaluationandmanagementfornoncardiacsurgery(JCS2003)ACCAHAGuidelinesforPerioperativeCardiovascularEvaluationforNoncardiacSurgery1980TheAmericanHeartAssociationAHATheAmericanCollegeofCardiologyACC2000812ACCAHAACCAHAEBMevidencedbasedmedicineobservationalstudyretrospectivestudyEBMempiricalACCAHA13GuidelinesforPerioperativeCardiovascularEvaluationforNoncardiacSurgery:ReportoftheAmericanCollegeofCirculationJournalVol.67,Suppl.IV,200311762001200211CardiologyAmericanHeartAssociationTaskForceonPracticeGuidelines1996ACCAHACommitteeonPerioperativeCardiovascularEvaluationforNoncardiacSurgeryACCAHA20014EBMevidencebasedmedicineACCAHAobservationalstudyretrospectivestudycriticalAHAACC124HighRisk2CirculationJournalVol.67,Suppl.IV,200311772221111434ACCAHA32235%5%1%3ASA3ASAClassClass4Class0.08%Class1.8%Class7.8%9.8%ClassClassCirculationJournalVol.67,Suppl.IV,20031178200120021Category1250mlCategory2500mlCategory35001500mlCategory41ICU1500ml25%5%1%3ClassClassClassClassClass2441¡730CanadianClass¡¡¡2¡CanadianClass¡Q¡¡3¡¡ST-T¡¡¡¡45115124ASAClass⁄¡6¡¡30¡¤¡¡¡¡¡¡4METSCirculationJournalVol.67,Suppl.IV,2003117957056103S311ECG75PVC7PaO260mmHg3PaCO250mmHg3K+3mEql3BUN50mgdl3Creatinine3mgdl334333Class051%Class6125%Class132511%Class2622%221212⁄STsegmentT1314¤1531617415%416%17204ST21227075%7080%2324824%90100%25293031325201Tl28595%8095%33420%95100%34434447CirculationJournalVol.67,Suppl.IV,20031180200120026⁄48¤495051‹8095%8595%52723%93100%535758596062637⁄2msec646768¤83697091%7172¡¡¡¡24CirculationJournalVol.67,Suppl.IV,20031181¡¡¡¡¡¡5¡ST-TofflineNICO1STsegment10737512234510767756CirculationJournalVol.67,Suppl.IV,2003118220012002237880SvO281868789790911234192959398110mmHg9993989495981002CABGACCAHACABGPTCACABGPTCAACCAHA3CirculationJournalVol.67,Suppl.IV,200311833331456101pneumaticcompression1011036Clagett1016510%104105106107102108CirculationJournalVol.67,Suppl.IV,2003118420012002640**40212pneumaticcompression408pneumaticcompression40pneumaticcompressionINR2.0-3.012INR2.0-3.0pneumaticcompression12pneumaticcompression12INR2.0-3.0pneumaticcompressionpneumaticcompressionpneumaticcompressionduplexultrasonographypneumaticcompression*Clagettetal.101**7abscess8CABGPTCAK9off-pumpbypass10109ST-segment1CirculationJournalVol.67,Suppl.IV,2003118532110111115riskbenefit114Targetcontrolledinfusion116BISbispectralindex117301102multi-centerstudy101187CirculationJournalVol.67,Suppl.IV,20031186200120023patient-controlledanalgegiapainscore11311542411912211.0gkgmin.2hypovolemiaHypovolemia5CirculationJournalVol.67,Suppl.IV,200311877¡¡¡¡¡¡¡¡¡¡806121243050%75125127riskbenefitSTSTcreatinekinaseCKMBfractiontroponinItroponinTCK-MBisoform1282,cost-effective129130cardioversioncardioversion131510132CABGPTCALDLHDLLDL100mgdL13312312hypovolemiaCirculationJournalVol.67,Suppl.IV,20031188200120023344123hypovolemiaXCTQTSTX11hypovolemiapitfallhypovolemiaSThypovolemiaCirculationJournalVol.67,Suppl.IV,20031189414234134hypovolemia135hypo-volemiarefillingoverhydrationsurgicaldiabetesXhypovolemia136137138XCTCirculationJournalVol.67,Suppl.IV,20031190200120024344evidencedelayedrepairpseudocoarctationCT1650%3050%111020139350%1391401241391412139142331143CirculationJournalVol.67,Suppl.IV,200311914555511NYHA144⁄146139145¤50mmHg25mmHg1451461471481491501330%146‹1392030mmHg151›80mmHg139146152fi14560%80%139flEbstein153154Ebstein155‡13990%85%156Fontan157°1391581592⁄CirculationJournalVol.67,Suppl.IV,200311922001200252139¤139‹›1393⁄567%410%612160160414%160162¤1634Marfan13914613513236aPTT233INR2.03.0a4low-profile17,50020,000U126aPTT23b36136CirculationJournalVol.67,Suppl.IV,20031193a2a346a13989139160CirculationJournalVol.67,Suppl.IV,20031194200120025381302g1.5mgkg80mg61.5g1.5g8211g11.5mgkg80mg8313g61.5g98Apgar12ACE13915754101641⁄40¤XXQSTT2CirculationJournalVol.67,Suppl.IV,200311955510123EisenmengerMarfan4cm85%20mmHg1111330CCSCCSQQ4⁄¤viability‹›fiST12PMI1CABGPTCA1CCS123viability2IABPXCirculationJournalVol.67,Suppl.IV,200311962001200212CABGcoronaryarterybypassgraftingPCIpercutaneouscoronaryinterventionACCAHATaskForceCABGPTCAPCICABGPCICABGCABGPCICABGPCIoffpumpCABGMIDCAB1⁄ACCAHAACirculationJournalVol.67,Suppl.IV,200311974METs4METs4METs4METs5CABGor30CCSor52CCSorQ1PTCA6CABG113¡¡350%¡250%CABG¤CABGstagedCABGCABGstagedCABG6cmCABGonpumpCABGoffpumpCABGCABGstagedaCABGCABGCABGstagedCABGstagedPMIoffpumpCABGCABGstagedCABG75%48K1ACTactivatedcoagulationtimebCABGCABGCABGstagedIABPCirculationJournalVol.67,Suppl.IV,2003119820012002‹CABGconventionalCABGoffpumpCABGoffpumpCABGPCIhybrid2⁄PCIACCAHAA12PCIPCI3culprit12PCICABGPCI¤PCIPCIPCI12PCI1PCIPCIPCIPCI12PCI6612CABG3IABPPMI3⁄IABPIABPIABPIABPXIABPAaCABGPCIbCirculationJournalVol.67,Suppl.IV,2003119930%fractionalshortening0.2CABGPCIcBACT150¤IABPIABPIABP18ACABGPCIscheduledIABPBIABPIABP‹PMIpendingstandbyIABP›IABPIABPscheduledIABP4CABGPCIIABPPMIvolumeV52cost-effectiveness1NLACirculationJournalVol.67,Suppl.IV,2003120020012002142TMLevine1⁄1701711150mmHg212172¤173174Circulation