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ID:27133324
大小:1.82 MB
页数:11页
时间:2018-12-01
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1、心胸麻醉进展Theadvancementofcardiothoracicanesthesia2012VAT房颤射频消融术术后6m有效率>90%TEE排除左心耳血栓胸外除颤电极无需肝素化OLV麻醉体会较侧卧易低氧症;阻断肺静脉时低血压。瓣膜病治疗进展Transcathetertransseptaldouble-orificerepair,短、中期明显缓解MVR.HemodynamicOutcomeofaDoubleMitraClipImplant(A)Bidimensionalechocardiographyat60°toshowtheintercommiss
2、uralview.Twoclipsareimplantedinthemiddleofthevalve.(B)Thediastolicflowshowsnoturbulence.(C)Aresidualminimaljetisfoundlaterallytothesecondimplantedclip.MinimallyInvasiveValveSurgery创伤小;相对长的主A阻断时间和CPB时间;相同死亡率和CNS损伤;股A灌注可能使老年病患术后中风风险高.麻醉体会OLV,体外除颤,放置右侧CVP(左颈内16~18F辅助静脉引流),TEE引导静脉导管置入,
3、CPB中持续CVP测量。示经股静脉插入的静脉引流管,需使其开口位于上腔静脉入口。TranscatheterAorticValveImplantation适用于不能耐受常规瓣膜手术的重度主动脉瓣狭窄病人,经股动、静脉,或经心尖。30d死亡率12~14%,而经心尖为6~10%麻醉挑战,心功差,高龄且合并症多全麻,或局麻结合深度镇静ADVANCESINCORONARYARTERYDISEASECoronaryArterySurgeryinHeartFailureAnassessmentofmyocardialviabilitydidnotcorrelatewith
4、enhancedsurvivalafterCABGsurgeryascomparedwithmedicaltherapy.Inpatientswithtriple-vesselcoronaryarterydisease,CABGsurgeryoffersbetterrelieffromanginathanPCIwithdrugelutingstents.Patientswithsignificantischemicbutviablemyocardiuminthedistributionofacoronaryarterywithsevereproximaldi
5、seaseshouldberevascularizedwhetherbyPCIorCABGsurgery.ADVANCESINHEMATOLOGYTheOralFactorXaInhibitorsRivaroxaban利伐沙班,Apixaban阿哌沙班拮抗药物尚处于研究阶段,prothrombincomplexThrombinInhibitorsDabigatran达比加群,快速起效,无需监测,但没有拮抗剂。其导致的严重出血需要recombinantactivatedfactorVII治疗BloodConservationPreoperativeInterv
6、entionsforBloodConservationErythropoeitinAntifibrinolyticTherapyFreshFrozenPlasma,RecombinantfactorVIIa,FactorXIII,FactorIXLeukoreduction,plateletplasmapharesis,andbloodsalvageareallcomponentsofamultimodalapproachtooptimizeperioperativetransfusionpractice.
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