脑血管疾病颈动脉内膜切除术的麻醉管理(双语).ppt

AnestheticManagementofCerebrovascularDiseaseCarotidEndarterectomy01DanielJ.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02脑血管疾病颈动脉内膜切除术的麻醉管理Stroke（中风）isthethirdleadingcauseofdeath.carotidarterydisease（劲动脉疾病）isasignificantanestheticissue（麻醉问题）forpatientsover50yearsofage.Astrokeoccursduetoocclusiveorhemorrhagicconditions.Occlusivecerebrovasculardiseasecanbethrombotic,embolic,orstenotic(血栓，栓塞或狭窄)inorigin.(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)Patientswithahistoryofpriorstroke（既往中风史）ortransientischemicattack（短暂性脑缺血发作）haveanincreasedriskofrecurrentperioperativestroke（围术期再次中风的危险）.Majorsymptomsofcarotidarterydiseaseincludechangesinvision,headache,changesinspeech,orfacial(发热)andextremity(四肢)weakness.Signs(体征)suggestiveofcarotidarterydiseaseincludeahigh-pitchedbruit(高亢的杂音)attheorigin(起源)oftheinternalcarotidartery,increaseinsizeandpulsation（强度）oftheipsilateral(同侧)superficialtemporalartery（颞浅动脉）,andchangesintheretinalexamination（眼底检查）.Confirmation（确诊）ofcarotidarterydiseaseisachievedbyvascularimagingwhichmayincludeultrasound,MRangiography,orcatheterangiography.（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）Presently,thereisinsufficient（不足的）informationtoregardingthetimingofsurgery（手术时机）followinganischemicepisode（缺血性发作）.Data（数据）suggeststhereisasmallbutrealincreaseinmorbidity（发病率）ifsurgeryisperformedshortlyaftertheonsetofsymptoms（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）Riskmaybeassociatedwiththepresence（存在）ofalowdensity（低密度）lesion（病变）onCTscan,vascularterritory（血管壁内）oftheinfarct（梗塞）,brainshift（脑组织移位）,andlevelofconsciousness（意识）.Carotidendarterectomy(CEA)（颈动脉内膜切除术）wasintroducedin1954astreatmentforocclusive（闭塞性）carotidarterydisease.Effic