TUESDAY, Oct. 1, 2024 -- In a clinical practice guideline issued by the American College of Cardiology and American Heart Association, published online Sept. 24 in both Circulation and the Journal of the American College of Cardiology, updated recommendations are presented for the perioperative cardiovascular management of noncardiac surgery.Annemarie Thompson, M.D., from Duke University Hospital in Durham, North Carolina, and colleagues note that a stepwise approach to perioperative cardiac assessment can help clinicians determine whether surgery should proceed or whether a pause for additional evaluation is necessary.

2024年10月1日，星期二——美国心脏病学会和美国心脏协会于9月24日在《循环》和《美国心脏病学会杂志》上在线发布的临床实践指南中，提出了非心脏手术围手术期心血管管理的最新建议。。

For patients undergoing noncardiac surgery, cardiovascular screening and treatment should adhere to the same indications as for nonsurgical patients, with careful timing to avoid delays in surgery. Stress testing should be performed judiciously, especially for those at lower risk and only in those in whom testing would be appropriate, regardless of planned surgery.When managing patients with complex anatomy or unstable cardiovascular disease, team-based care should be emphasized, the authors note.

对于接受非心脏手术的患者，心血管筛查和治疗应遵循与非手术患者相同的适应症，并谨慎选择时机，以避免手术延误。压力测试应该明智地进行，特别是对于那些风险较低的人，并且只有那些测试合适的人，无论计划的手术如何。作者指出，在管理解剖结构复杂或心血管疾病不稳定的患者时，应强调基于团队的护理。

There are significant perioperative implications for new therapies for management of diabetes, heart failure, and obesity. To minimize the risk for perioperative ketoacidosis associated with their use, sodium glucose-cotransporter 2 inhibitors should be discontinued three to four days before surgery.

对于糖尿病，心力衰竭和肥胖症的治疗，新疗法具有重要的围手术期意义。为了最大程度地降低围手术期酮症酸中毒的风险，应在手术前三至四天停用钠-葡萄糖协同转运蛋白2抑制剂。

Myocardial injury after noncardiac surgery is a newly identified disease process, which should not be ignored. The risk for stroke is increased for patients with newly diagnosed atrial fibrillation identified during or after noncardiac surgery. Only patients at highest risk for thrombotic complications should use perioperative bridging of oral anticoagulant therapy.

非心脏手术后的心肌损伤是一种新发现的疾病过程，不应忽视。非心脏手术期间或之后发现的新诊断房颤患者中风风险增加。只有血栓并发症风险最高的患者才应该使用口服抗凝治疗的围手术期桥接。