StefanDe Hert 心脏高危患者的术中管理-培训课件.ppt

七氟烷 丙泊酚 七氟烷 丙泊酚 咪达唑仑 七氟烷 丙泊酚 咪达唑仑 七氟烷 丙泊酚 咪达唑仑 咪达唑仑 结论 吸入麻醉药具有器官保护作用 吸入麻醉药的临床器官保护效应主要体现于心脏手术 吸入麻醉药对于非心脏手术的器官保护效应 尚需进一步的临床试验 * In the mean time our knowledge on perioperative myocardial ischemia and the potential influence of anesthetic strategies has markedly improved and new insights have been gained which I will now summarize for you. * Let’ go back for a moment to basic physiology and pathophysiology. What happens with myocardial ischemia? * * Let’s start with the factor myocardial oxygen balance * Look more in detail in strategies to improve myocardial oxygen balance As we have seen one strategy is to decrease the influence of the factors that may increase the determinants of myocardial oxygen demand such as loading conditions, heart rate and others. This can be obtained by decreasing perioperative stress The use of neuraxial techniques has been claimed to reduce perioperative stress but does this result in a better outcome? * Several studies looked at postoperative outcome with locoregional anesthesia BUT small numbers of patients We have to rely on review databases, systematic reviews and meta-analyses No difference in complications There is insufficient evidence to confirm or deny the ability of postoperative analgesic techniques to affect major postoperative morbidity or mortality. This is primarily due to insufficient subject numbers to detect differences in currently low incidences of postoperative complications. Even for pain outcome, data are not straightforward. This is related to the poor sensitivity of scores of pain and patient satisfaction. * Myocardial infarction Mortality Cave with interpretation, depends on the individual studies 3. For instance, one study has a 28% mortality in the control group * Lower incidence of renal failure but very high incidence in two studies, which may distort the findings As was argued in a letter on this article * Of course decreasing the myocardial oxygen balance can also be obtained with the classi