2．心循環器疾患合併患者の周術期管理の留意点

Perioperative Management for Patients with Cardiovascular Diseases in General Thoracic Surgery

呼吸器外科手術を受ける患者の多くは高齢の喫煙者であり，心循環器疾患と同様なリスク因子を有しているため，その併存頻度は高い1）．2018年の日本胸部外科学会学術調査2）によると，原発性肺癌手術例における術後死亡のうち死因が心血管疾患であるのは8.9％と報告されており，周術期における心循環器疾患の評価と管理は重要である．また，肺癌手術などの待機的非心臓手術を受けた心不全合併患者は，心不全非合併期患者と比し，症状の有無にかかわらず90日死亡リスクが有意に高いとの報告もある3）．

For general thoracic surgeons, perioperative management for the prevention of cardiac complications is important because patients undergoing general thoracic surgery often have risk factors for cardiac diseases. Some risk-scoring systems can estimate a patient’s risk of perioperative cardiac complication. Surgery-specific risk for intrathoracic surgery is intermediate. Preoperative evaluation for coronary artery disease should be considered only in high-risk patients based on the risk-scoring system and surgery-specific risk. If coronary artery disease is detected in a preoperative patient, the treatment, such as percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） should not be preoperatively performed as much as possible, because it requires antithrombotic therapy for at least a couple of months and may cause a delay for general thoracic surgical treatment. In high-risk patients for perioperative coronary artery disease, the 12-lead electrocardiogram is recommended for part of routine clinical care during the early postoperative period. The development of perioperative heart failure after noncardiac surgery is a high risk of operative mortality and hospital readmission. Transthoracic echocardiography should not be routinely performed as a preoperative examination, it can help detect underlying heart failure and valvular diseases and contribute to more appropriate postoperative management. Frequent monitoring of vital signs, oxygen saturation, and chest X-rays are important for the early detection of postoperative heart failure.