胸腹主动脉瘤手术的麻醉处理ppt课件_1.ppt

一、腹主动脉瘤病因及发病机制 1.吸烟 烟草燃烧产生的气态物质进入血液，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的降解，引起 动脉壁力量减弱而导致动脉瘤的形成。;2.高血压 与发病率和破裂的危险性有密切的关系;4.炎症反应 慢性炎症反应中的巨噬细胞和活化的T、B淋巴细 胞可刺激金属蛋白酶的产生，促进结缔组织的降解， 削弱和破坏主动脉壁中层，导致产生动脉瘤。;;二、腹主动脉瘤的病理改变 1.真性动脉瘤：动脉粥样硬化是常见原因。 动脉粥样硬化的危险因素：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、诊断 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 影像学检查;四、胸腹主动脉瘤的手术方式及概况 手术方式： 1.Open repair 2.Medal graft stent 3.Baloon-expandable 4.Hand-help laparoscope repair ; Elective surgery by open transperitoneal or retroperitoneal approach is the most common repair intervention. However, placing an endoluminal stent graft within the aneurysm is currently being evaluated as an alternative to open repair. ; Newer, minimally invasive catheter-based endovascular technology utilizing stent grafts are currently being evaluated for abdominal aortic aneurysm (AAA) repair. ;平均年龄 68.5 +/-7.7 years. 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%, 肾功能不全 10%, 吸烟史 80%. ;Complications: Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest , septicemia , acute myocardial infarction, acute renal failure , surgical complications after a procedure , and reoperation for bleeding . The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure. ;五、麻醉方法及术中处理;;;;对于术前服用抗凝药物的病例处理;Procedures performed before anesthesia: Collection and storage of patient，s own blood in the weeks preceding surgery. Prescribe premedication. A warming blanket is necessary in the anesthetic room. Mornitoring.;Procedures performed before surgery starts: 1.A suitable vein or veins are cannulated with at least one 14-gauge cannula for infusion of warmed fluids. 2.Cannulation of a radial artery. 3.Central venous catheterization for measure- ment of right a