慢性肺栓塞的外科治疗宋云虎PPT.pptVIP

慢性肺栓塞的外科治疗;背 景;慢性肺栓塞的概念; ;诊断手段;CTEPH治疗选择;Fuwai Hospital;资 料 与 方 法;CTEPH 病人;阜外医院肺动脉栓塞病人的收治情况 (1997-2008.6);阜外医院近年PEA手术例数;男：35例 女：11例 平均年龄: 46.1 岁 平均病史: 45.1 月 ;临床表现;双侧病变 32 例;手术方法;平均体外循环时间: 160.3 min 平均升主动脉阻断时间: 72.2 min 平均停循环时间: 44.6 min 同期手术如下表;Expose RPA and RPA incision;RPA incision;Create resection plane;Fuwai Hospital;Fuwai Hospital;Fuwai Hospital;结 果;手术死亡率: 8.7% (4/46) 平均气管插管时间: 75.2 h 肺水肿: 10（21.7％） 术后早期严重肺动脉高压: 6（13.0％） 神经系统并发症: 7（15.2％）;Fuwai Hospital;术前 ;术前 ;术前;术前;PEA术后肺灌注 改善;随访结果 ;4例死亡原因;;讨 论;PEA的手术适应症是什么? 影响PEA术后效果的因素?;PEA手术适应症;Type;PVR与手术死亡率相关;药物治疗;药物治疗;Pre-PEA “Bridging” therapy;Post-PEA therapy;术后ECMO的运用;Fuwai Hospital;PEA是治疗CTEPH的安全而有效的方法，且具有良好的中远期结果。手术适应症与手术时机的判断影响手术疗效，也存在争议。;THE END;PULMONARY THROMBOENDARTERECTOMY;BACKGROUND;CONCEPTION OF CTEPH; ;DIAGNOSTIC METHODS;ANGIOGRAPHY AND MRI;NATURAL HISTORY;TREATMENT OF CHOICE;Fuwai Hospital;DATA AND METHODS;CTEPH PATIENTS;PE in FUWAI HOSPITAL (1997-2008.6);PEA IN FUWAI HOSP IN RECENT YEARS;male：35 female：11 Mean age: 46.1 years Mean history: 45.1 mon;CLINICAL MANIFESTATION;Bilateral disease 32 cases;OPERATION METHODS;Mean CPB time: 160.3min Mean AOC time: 72.2min Mean cardiac arrest time: 44.6 min Associated management;Expose RPA and RPA incision;RPA incision;Create resection plane;Fuwai Hospital;Fuwai Hospital;Fuwai Hospital;RESULTS;OP mortality: 8.7% (4/46) Mean intubation time: 75.2 h Pulmonary edema: 10（21.7％） Early postop-severe PH: 6（13.0％） CNS complication: 7（15.2％）;Fuwai Hospital;PRE-OP ;preop ;preop;preop;Pulmonary perfusion improved postop;FOLLOWUP ;Causes of 4 death during followup;time;DISCUSSION;INDICATION OF PEA? FACTORS RELATED TO PROGNOSIS OF PEA?;INDICATION OF PEA;Type;RELATIONSHIP BETWEEN PVR AND MORTALITY;Medical treatment can improve prognosis;DRUGS;Pre-PEA “Bridging” therapy;Post-PEA therapy;ECMO;CONCLUSION;PEA is a safe and effective method to treat CTEPH and with satisfactory mid- and long-term resultspreop evalu