脑血管疾病颈动脉内膜切除术的麻醉管理（双语）PPT课件.pptVIP

Anesthetic Management of Cerebrovascular Disease Carotid Endarterectomy;Introduction; 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;Carotid Artery Revascularization（颈动脉再灌注）;Anatomic/Physiologic（解剖/生理学） Considerations;Preoperative Concerns（术前关注点）;Other factors which have been reported to increase neurological risk include:（其他有报道的增加神经系统风险的因素包括）;Medical complications occur about 10% of the time after CEA and are associated with the following:（CEA后并发症的发生还与下列有关）;Monitoring （监控）;Monitoring （监控）;;Monitoring （监控）;Anesthetic Management;Anesthetic Management;Anesthetic Management;Modalities of Cerebral Protection脑保护的方式;Physiologic:（生理） 1. Hypothermia（低温）-much has been studied about the beneficial（有益） effect of mild hypothermia（低温） on cerebral ischemia（脑缺血）. Accordingly, is the concern that if hypothermia is employed as a cerebral protectant for CEA, many patients may suffer from shivering during recovery; and a consequent increase in myocardial oxygen consumption which may precipitate myocardial ischemia. Thus, routine employment of hypothermia is not recommended for patients undergoing CEA. Conversely, hyperthermia should be avoided.（很多研究已经表明低温对脑缺血的有利，但是，如果采用低温作为CEA术中的脑保护剂，许多患者可出现在恢复过程中寒战发抖以及心肌耗氧量的增加可能诱发心肌缺血，因此，不建议常规对接受CEA的患者进行低温麻醉，相反，应避免高温）;2. Hyperglycemia（高血糖）-should be avoided（避免） and treated（处理） when possible. 3. Hypertension（高血压）-during ischemia, autoregulation（自动调节） is impaired and CBF is dependent on perf