主动脉夹层手术的麻醉ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,主动脉夹层手,术的麻醉,皖南医学院弋矶山医院麻醉科,王立鹏,LOGO,主动脉夹层手,1,Contents,1.主动脉夹层病理生理特点,2.麻醉前访视与评估,3.麻醉诱导与维持,4.麻醉管理重点,Contents,2,主动脉夹层定义,主动脉内膜和中层弹力膜发生撕裂,血液进入主动,脉中层形成壁间假腔,并与主动脉真腔相交通,称为主动脉夹层。,致病因素:,高血压病史(约80%患者),性别(男性居多),结缔组织病(马凡氏综合征),先天性心脏病,主动脉夹层定义,3,分型,Stanford A型,Stanford B型,累及升主动脉,仅累及降主动,和弓部主动脉,脉起始以远的,约占60%,部位,约占,75,25%-40%,分型,4,A型夹层,升主动脉,全弓置换+,升主动脉,Bental人工血管,象鼻支架,置换,置换术,置入术,sun氏术,A型夹层,5,主动脉夹层病理生理特点,高血压波动幅度,多中心临床与动物实验发现:,1.80%以上的主动脉夹层患者患有高血压,部分患者主动脉囊性中层,坏死,2.高血压并非是囊性坏死的原因,但可促进其进展。,3.血压波动的幅度而不是血压值高度与主动脉夹层分裂相关,研究表明:血压波动的幅度破坏了主动脉血管的自我调节,性和代偿能力,主动脉夹层病理生理特点,6,主动脉夹层病理生理特点,主动脉通道功能严重受损:真腔血流受阻+裂开的夹层形,成双腔主动脉。,主动脉通道功能丧失:,冠状A、头臂干/左颈总A、肾A等血管断流心、脑、,肾重要脏器缺血,主动脉夹层病理生理特点,7,主动脉夹层病理生理特点,心脏压塞、心律失常等心脏,并发症,主动脉夹层破裂,脑、肾等,循环衰竭,多器官缺血,主动脉夹层病理生理特点,8,Circulation2019se281221312839.d101181 RCULATIONAHA 109.92942.:20198013.,Importance of refractory pain and hypertension in acute type B aortic dissection: insights from,the International Registry of Acute Aortic Dissection (IRADI,Primarch s,Ee,既如,SP出 chanson S! Ramnoldiv Grassi, 9ossone E距m啪,A, Tsai TT, Froehlich JB, Cooper y, Montgomery D, Meinhard G, Myrmel T, Unchurch GR, Sundt TIn, Isselbacher EM International Registry of Acute Aortic,4 Author intormation,Abstract,BACKGROUND: In patients with acute type B artic dissection, presence Df recurrent or retractory pain and/or refractory hypertension,medical therapy is sometimes used as an indication far imvasle treatment The International Registy of Acute Aortic dissection,IRAD) was used to invest gate the impact of refractory pain andr or refractory rypertension on the outcomes of acute type B aortC,dissection,METHODS AND RESULTS: Three hundred sity-five patients affected by uncomplicated acute type B aortic dissection, enrolled in RAD,tom 2019 to 200, were categorized according to nsk prot le into 2 groups Patients worth recurrent and or refractory pain or retractory,ypertension (group l n=69 and patents without clinical complicat ons at presentation (group ll n=296) were compared. High-risk,Iatients mth classic complications were Excluded from this analysis. The overall in-hospital mortality Mras 6.5% and n as increased in,group I compared with group ll(17. 49 versus 4.0% P=0.000S). The in-hospital mortality after medical management wras signif cantly,icreased in group I compared with group l356% versus 1 6% P=.0003)Mortality rates after surgical 20 versus 28% P=0.74),ement(S.7% versus 9. 1%5 P=0. 50)did not differ significanty between graup l and group I, respectively. A,ulb variable logistic regression model confirmed that recurrent andor refractory pain or refractory hypertension was a predictor of ink,hospital mortal ity odds ratio, 3.31: 95% confidence interval, 1.04 to 10.45, P=0.041,CONCLUSIONS: Recurrent pain and r,particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach,may be indicated in this intermediate-risk group,Circulation2019se281221312839.,9,jac,201日.01.064,Presenting Systolic Blood Pressure and outcomes in Patients With Acute Aortic Dissection.,Bossone E1 Gorla R, LaBounty Thd 3 Suzuki, Gilon D5, strauss c5 Ballotta A Patel HJB, Evangelista A9. Ehrlich Mp10. Hutchison 511, Kllne-Rogers,三ak,t Author intormation,Abstract,BACKGROUND: Presenting systolic blood pressure (SBP)is a powerful predictor of mortality in mamy cardiovascular settings, including,OBJECTIVES: This stucty evaluated the association of presenting SEP with in-hosptal outcomes. specifically alk-cause mortality. in,METHODS: T he study included 6, 23B consecutive patients (4, 167 woth bype A and 2. 07 1 wnth type B AAD) enrolled in the International,RegIsty of Acute aorti,ton. Patients were stabled in 4 groups according to presenting sBP: SBP 150, 5BP 101 to 150, SBP,se0 mm Hd,RESULIS: The relationship beteen presenting SBP and in-hospital mortality displayed a J-curve association, unth signif canty higt,mortality rates in patients with vel,BP 26.3% for sBP 180 mm Hg in type A AAD, 13.3%5 for sBP 200 mm Hg in type B AAD,0.005 and p=0.018, respective)as well as in those suit SBP $100 mm Hg (29.9%o in type A, 22.4 in type B, p=0.035 and,p=0.015, respectivelyl. This relationship was mainly from increased rates of in-hospital camplications (acute renal failurE, coma, and,mesenteric ischemiaanfarction in patients wth sBP 15D mm Hg: stroke, coma, cardiac tamponade, myocardial ischemia/nfarction,and acute renal failure in patients with SBP s80 mm Hg). Notably presenting SEP sBU mm Hg mas independently associated with in-,ospital mortality in both tpe A p=0. 001)and type B AAD(p=0.003),CONCLUSIONS: Presenting SEP showed a clear J-curve relationship with in-hospital mortality in patients with AAD. Although this,ssociabonwas related to increased rates of comor bid conditions at the edges of the curve, SaP sad mrm Hg was an independet,elate oT in-nospltal mortalit,jac,201日.01.064,10,主动脉夹层手术的麻醉ppt课件,11,主动脉夹层手术的麻醉ppt课件,12,主动脉夹层手术的麻醉ppt课件,13,主动脉夹层手术的麻醉ppt课件,14,主动脉夹层手术的麻醉ppt课件,15,主动脉夹层手术的麻醉ppt课件,16,主动脉夹层手术的麻醉ppt课件,17,主动脉夹层手术的麻醉ppt课件,18,主动脉夹层手术的麻醉ppt课件,19,主动脉夹层手术的麻醉ppt课件,20,主动脉夹层手术的麻醉ppt课件,21,主动脉夹层手术的麻醉ppt课件,22,主动脉夹层手术的麻醉ppt课件,23,主动脉夹层手术的麻醉ppt课件,24,主动脉夹层手术的麻醉ppt课件,25,主动脉夹层手术的麻醉ppt课件,26,主动脉夹层手术的麻醉ppt课件,27,主动脉夹层手术的麻醉ppt课件,28,主动脉夹层手术的麻醉ppt课件,29,主动脉夹层手术的麻醉ppt课件,30,主动脉夹层手术的麻醉ppt课件,31,主动脉夹层手术的麻醉ppt课件,32,主动脉夹层手术的麻醉ppt课件,33,主动脉夹层手术的麻醉ppt课件,34,主动脉夹层手术的麻醉ppt课件,35,