术中监测与预后课件

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,*,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,Hong Ma,MD,Ph.D Jun Wang Fengshou Chen,Department of Anesthesiology,The First Hospital of China Medical University,Impact of Monitoring Technique on the Outcomes of Perioperative Patients,Introduction,regional cerebral oxygen saturation monitoring,cerebrospinal fluid drainage,and pressure,v,isualization technique,depth of anesthesia,(,BIS,),body temperature,（,hypothermia,）,Introduction,regional cerebral oxygen saturation monitoring,cerebrospinal fluid drainage,and pressure,v,isualization technique,depth of anesthesia,(,BIS,),body temperature,（,hypothermia,）,C,erebral oxygen saturation monitoring and outcomes,Perioperative cerebral oxygenation assessed by near-infrared spectroscopy can,detect,hypoxic-ischemic conditions associated with injury,and,reduced neurodevelopmental performance,Circulation.2010;122:245-254,Monitoring cerebral rSO2 in coronary artery bypass patients,avoids profound cerebral desaturation,and is associated with significantly,fewer incidences of major organ dysfunction,.,Anesth Analg.2007;104:51-58,CONCLUSION,：,POCD,is common and persistent in older adults following surgery.The results of the nested RCT indicate the potential benefits of intra-operativemonitoring of anesthetic depth and,cerebral oxygenation,as a pragmatic intervention toreducepost-operativecognitiveimpairment.,C,erebral oxygen saturation monitoring and outcomes,C,erebral oxygen saturation monitoring,Cardiopulmonary bypass,especially deep hypothermic cardiopulmonary bypass,Major vascular surgery,(carotid artery operation),Critically ill patients or elderly patients,Introduction,regional cerebral oxygen saturation monitoring,cerebrospinal fluid drainage,and pressure,v,isualization technique,depth of anesthesia,(,BIS,),body temperature,（,hypothermia,）,TAA(TAAA)and spinal injury,Paraplegia or paraparesis are the,catastrophic complication of TAAA surgery.,I,ncidence rate:In type II thoracic and abdominal aortic aneurysm surgery the rate is between 6.6-8.3%,even up to 22%.,Ann Surg.2003;238:372-380,Ann Thorac Surg.2005;80:1280-1288,Ann Thorac Surg.2002;73:1107-1115,CSF Drainage:the most important strategy of spinal cord protection,CSF Drainage could significantly attenuate the incidence rate of complication after the thoracic(abdominal)aortic aneurysm surgery:13%vs 2.6%.,Cerebrospinal fluid drainage significantly improved,late-onset neurologic deficit,that occurred between 1 day and 2 weeks after operation,timelylumbar cerebrospinal fluid drainage can reverse,late-onset spinal injury,Anesth Analg.2010;111:46-58,J Vasc Surg.2002;35:631-639,J Vasc Surg.1997;26:616-622,Curr Opin Anaesthesiol 2010;23:95-102,Cerebrospinal fluid drainage,Cerebrospinal fluid,pressure,CSF Drainage is an effective treatment of the delayed spinal cord injury,The pressure of CSF,could increase before the appearing of delayed spinal cord injury.,J Wasc Surg.1997;26:616-622,Cerebrospinal fluid,pressure,Treatment for,delayed spinal cord injury,Complications,RESULT:Twenty-four patients(,5%,)had,bloody spinal fluid,.CT exams showed seven had no evidence of intracranial hemorrhage,14(2.9%),had,intracranial blood without neurologic deficit,and,three,with,intracranial bleeding and cerebral atrophy had neurologic deficits,(1 died,1 had permanent hemiparesis,and 1 with transient ataxia recovered fully).,J Vasc Surg,.,2009;49(1):29-34,Complications,Complications,J Vasc Surg,.,2009;49(1):29-34,A high associated mortality of 40%when intracranial hemorrhage occurred with CSFD.,the majority of hemorrhagic events were cerebellar hemorrhage.,approach to the“bloody or blood-tinged”CSF is to stop draining and correct any coagulopathy.,Complications,Cerebrospinal fluid drainage to prevent paraplegia during TA and TAAA surgery,Cerebrospinal fluid drainage is now used in our department to reduce the rate of paraplegia and protect spinal cord function,during,repair of TAAAs.,CASE 1,：,Male,，,48-year-old.,Chief Complaint,：,Back pain for 12 hours.,Past medical history,：,ascending aorta replacement,hemi-aortic arch replacement for 7 years.,Diagnosis,：,Aorta Dissection Stanford B.,Operation,：,total arch replacement,，,stent-graft deployment,，,CABG.,1,st,day postoperation,：,the patient suffered paraplegia.,Strategy,：,CSF Drainage.,2,nd,day postoperation,：,the symptom relieved.,After 11 days,：,the patient recovered.,CASE 2,：,Male,，,39-year-old.,Chief Complaint,：,abdominal pain for 12 hours.,Diagnosis,：,Aorta Dissection Stanford A.,Operation,：,ascending aorta replacement,，,total arch replacement,，,stent-graft deployment.,2,nd,day postoperation:the patient suffered paraparesis,the right lower extrimity suffered akinesia.,Strategy,：,CSF Drainage.,4,th,day postoperation,：,the symptom relieved.,After 8 days,：,the patient recovered.,Introduction,regional cerebral oxygen saturation monitoring,cerebrospinal fluid drainage,and pressure,v,isualization technique,depth of anesthesia,(,BIS,),body temperature,（,hyp