美国asa麻醉进展.pptVIP

2008年美国麻醉学几点回顾 温州医学院附属第一医院 汪炜健 经皮冠状动脉裸支架或药物支架介入术后手术的时间和心脏风险 01—06年短短的5年期间，全世界600万人接触了支架 药物支架后期的血栓的机会增多 非心脏手术后认知功能障碍的预测因子 Monk 等人在他的研究中提到对于POCD的认识延伸到了既往观察的非心脏手术中，同时调查了病死率和发病率。 1064名经历开腹手术、开胸手术或者关节手术的病人在术前、出院时和出院3个月后接受神经心理测试。 预测因子 Age Years of education Baseline instrumental activities of daily living, by patient ASA physical status Duration of hospital stay POCD at hospital discharge 提醒我们需要更好的了解急性POCD的跨年龄问题 第一次呈现了这一前瞻性情况研究显示在术后认知功能的下降和老年人死亡率之间存在关联 发生POCD的根本原因，以及懂得预防和处理导致主要病死率和发病率的潜在方法 心脏术后出血:止血环酸对于纤溶酶原激活物抑制剂-1基因多态性为5G纯合子病人的作用 各种研究和使用抗纤维蛋白溶解药减少出血的实验中，其有效性产生了复杂的结果 一种解释这种矛盾现象的假设是，纤溶酶原激活物抑制剂-1（PAI-1）的遗传多态性， 4G的等位基因与提高PAI-1的水平有关，而5G的等位基因与降低PAI-1的水平有关 问卷调查: 一种筛选睡眠呼吸暂停病人的工具 （OSA）患病率在普通人群中超过26%，而在特殊病人中，例如肥胖病人，发病率超过70%。 OSA还会与某些疾病密切相关，如心血管疾病，脑血管疾病以及胃食管疾病。 提高了围手术期并发症的发生率；与普通人相比，寿命减少20年。 OSA可明显增加患者呼吸道处理和麻醉管理的难度.但是,有超过80%的OSA患者在术前并未能得到确诊 STOP Questionnaire 1. Snoring Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? 2. Tired Do you often feel tired, fatigued, or sleepy during daytime? 3. Observed Has anyone observed you stop breathing during your sleep? 4. Blood pressure Do you have or are you being treated for high blood pressure? High risk of OSA: answering yes to two or more questions Low risk of OSA: answering yes to less than two questions STOP-Bang Scoring Model 1. Snoring Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? 2. Tired Do you often feel tired, fatigued, or sleepy during daytime? 3. Observed Has anyone observed you stop breathing during your sleep? 4. Blood pressure Do you have or are you being treated for high blood pressure? 5. BMI BMI more than 35 kg/m2? 6. Age Age over 50 yr old? 7. Neck circumference Neck circumference greater than 40 cm? 8. Gender Gender male? High risk of OSA: answering yes to three or more items Low risk of OSA: answering yes to less than thre