脑血管疾病颈动脉内膜切除术的麻醉管理双语__培训课件.ppt

Anesthetic Management of Cerebrovascular Disease Carotid Endarterectomy Daniel J.Cole,M.D.Phoenix, Arizona 翻译：福建医科大学附属协和医院麻醉科规培住院医师：曾燕 脑血管疾病颈动脉内膜切除术的麻醉管理 Introduction Stroke （中风）is the third leading cause of death. carotid artery disease（劲动脉疾病） is a significant anesthetic issue （麻醉问题）for patients over 50 years of age. A stroke occurs due to occlusive or hemorrhagic conditions. Occlusive cerebrovascular disease can be thrombotic, embolic, or stenotic(血栓，栓塞或狭窄)in origin.(闭塞性或出血性中风的发生是由于闭塞性脑血管疾病，血栓，栓塞或起源于狭窄) Patients with a history of prior stroke （既往中风史）or transient ischemic attack（短暂性脑缺血发作） have an increased risk of recurrent perioperative stroke （围术期再次中风的危险）. 简介 Major symptoms of carotid artery disease include changes in vision, headache, changes in speech, or facial(发热) and extremity(四肢) weakness. Signs(体征) suggestive of carotid artery disease include a high-pitched bruit (高亢的杂音)at the origin(起源) of the internal carotid artery, increase in size and pulsation（强度） of the ipsilateral (同侧)superficial temporal artery（颞浅动脉）, and changes in the retinal examination（眼底检查）. Confirmation（确诊） of carotid artery disease is achieved by vascular imaging which may include ultrasound, MR angiography, or catheter angiography.（颈动脉疾病的确认是通过血管成像，其中可能包括超声，磁共振血管造影或导管造影） Introduction Presently, there is insufficient （不足的）information to regarding the timing of surgery （手术时机） following an ischemic episode（缺血性发作）. Data（数据） suggests there is a small but real increase in morbidity（发病率） if surgery is performed shortly after the onset of symptoms（症状）.（数据表明，如果进行手术后不久出现症状，有一个小，但真正的发病率增加） Risk may be associated with the presence（存在） of a low density（低密度） lesion （病变）on CT scan, vascular territory（血管壁内） of the infarct（梗塞）, brain shift（脑组织移位）, and level of consciousness（意识）. Carotid Artery Revascularization（颈动脉再灌注） Carotid endarterectomy (CEA) （颈动脉内膜切除术）was introduced in 195