Monitoring und Behandlung perioperativer kardiovaskulärer Erkrankungen

Zusammenfassung

Nach der koronaren Herzerkrankung und dem Schlaganfall stellt perioperative Mortalität die dritthäufigste Todesursache in den westlichen Industrieländern dar. Die individuelle, klinische Risikobewertung ist deswegen von besonderer Bedeutung. Die perioperative Mortalität beruht zum überwiegenden Anteil auf perioperativen Myokardinfarkten (PMI), die häufig klinisch stumm verlaufen und nur durch systematische hs-TnT/I-Messungen frühzeitig erkennbar werden. In den neuesten ESC-Leitlinien zu nicht kardialen, chirurgischen Eingriffen wird deswegen die perioperative hs-TnT/I-Überwachung empfohlen. Dadurch sollen Typ-1- und Typ-2-Myokardinfarkte schneller erkannt und behandelt werden. Auch nicht koronare Ursachen wie Herzrhythmusstörungen, Infektionen, Sepsis, Lungenembolie, Nierenfunktionsstörungen, Schlaganfall, Subarachnoidalblutung und chronische Lungenerkrankungen können zu einem hs-TnT/I-Anstieg führen. Da viele Hochrisikopatienten bereits präoperativ erhöhte hs-TnT/I-Werte aufweisen, sollte eine hs-TnT/I-Bestimmung bereits präoperativ durchgeführt werden.

Abstract

Perioperative mortality is the third most common cause of death after ischemic heart disease and stroke. Individual clinical risk assessment is therefore crucial. A relevant contribution to postoperative mortality is made by perioperative myocardial infarctions (PMI). In the majority of cases, these are clinically silent and are only recognized by systematic hs-TnT/I measurements. In the latest ESC guidelines for non-cardiac surgery, perioperative hs-TnT/I monitoring is, therefore, recommended. This is intended to detect and treat type 1 and type 2 myocardial infarctions more quickly. However, non-coronary causes such as cardiac arrhythmias, infections, sepsis, pulmonary embolism, renal dysfunction, stroke, subarachnoid hemorrhage and chronic lung diseases can also increase hs-TnT/I levels. Since many high-risk patients already have elevated hs-TnT/I values, preoperative assessment of hs-TnT/I levels should be performed.

Was ist wichtig?

• Die perioperative Mortalität bei nicht kardialen Operationen beträgt 1–2%.

• Dabei beruhen 50% auf kardiovaskulären Komplikationen wie perioperativer Myokardinfarkt (PMI).

• Durch perioperative Bestimmungen von hs-TnT/I werden PMI früher erkannt.

• Zur weiteren Differenzierung von nicht kardialen und kardialen Ursachen ist eine Echokardiografie notwendig.

Schlüsselwörter

Myokardischämie - perioperative Myokardverletzung - hs-Troponin

Keywords

myocardial ischemia - hs-troponin - perioperative myocardial injury (PMI)

Publikationsverlauf

Artikel online veröffentlicht:
08. Februar 2024

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