胸腹主动脉瘤手术的麻醉处置专家讲座.pptxVIP

胸腹主动脉瘤手术麻醉处理;一、腹主动脉瘤病因及发病机制

1.吸烟

烟草燃烧产生气态物质进入血液，可将

蛋氨酸氧化成蛋氨酸亚砜，蛋白水解酶活性

增加，加重了动脉壁弹力蛋白降解，引发

动脉壁力量减弱而造成动脉瘤形成。;2.高血压

与发病率和破裂危险性有亲密关系;4.炎症反应

慢性炎症反应中巨噬细胞和活化T、B淋巴细

胞可刺激金属蛋白酶产生，促进结缔组织降解，

减弱和破坏主动脉壁中层，造成产生动脉瘤。;;胸腹主动脉瘤手术的麻醉处置专家讲座;二、腹主动脉瘤病理改变

1.真性动脉瘤：动脉粥样硬化是常见原因。

动脉粥样硬化危险原因：高胆固醇血症、糖尿病、肥胖、

高血压、吸烟史，男性，等等。

2.假性动脉瘤：多见与动脉损伤。

3.夹层动脉瘤：动脉壁中层囊性坏死或退行

性变。;三、诊疗

腹部搏动性包块

神经压迫症状

下肢缺血症状

血管造影、CT、MRI、高速螺旋CT等

影像学检验;四、胸腹主动脉瘤手术方式及概况

手术方式：

1.Openrepair

2.Medalgraftstent

3.Baloon-expandable

4.Hand-helplaparoscoperepair;Electivesurgerybyopentransperitonealorretroperitoneal

approachisthemostcommonrepairintervention.However,

placinganendoluminalstentgraftwithintheaneurysmis

currentlybeingevaluatedasanalternativetoopenrepair.;Newer,minimallyinvasivecatheter-basedendovascular

technologyutilizingstentgraftsarecurrentlybeingevaluated

forabdominalaorticaneurysm(AAA)repair.;平均年纪68.5+/-7.7years.

高血压病史55%,心脏病73.5%,

外周血管疾病21%,中风和短时间缺血22%,

糖尿病7%,

肾功效不全10%,

吸烟史80%.;Complications:

Complicationratesvariedwidelyamonghospitals.Complications

independentlyassociatedwithincreasedriskofin-hospitaldeath

includecardiacarrest,septicemia,acutemyocardialinfarction,

acuterenalfailure,surgicalcomplicationsafteraprocedure,and

reoperationforbleeding.

Thepopulation-attributableriskforin-hospitalmortalitywas

47%forcardiacarrestand27%foracuterenalfailure.;五、麻醉方法及术中处理;;;;胸腹主动脉瘤手术的麻醉处置专家讲座;对于术前服用抗凝药品病例处理;Proceduresperformedbeforeanesthesia:

Collectionandstorageofpatient，sown

bloodintheweeksprecedingsurgery.

Prescribepremedication.

Awarmingblanketisnecessaryinthe

anestheticroom.

Mornitoring.;Proceduresperformedbeforesurgerystarts:

1.Asuitableveinorveinsarecannulatedwith

atleastone14-gaugecannulaforinfusionof

warmedfluids.

2.Cannulationofaradialartery.

3.Centralvenouscatheteriza