腹主动脉瘤诊断治疗与护理（优质课件）.ppt

* * Arteries are composed of three layers: ADVENTITIA The outer layer of the artery Composed primarily of connective tissue and elastic fibers Provides elastic and structural strength to the artery MEDIA The middle layer of the artery Composed of smooth muscle tissue Provides strength to the artery by allowing constriction/dilation. Weakening of this layer usually results in an aneurysm. Receives blood supply by diffusion and is innervated by the sympathetic nervous system. INTIMA The innermost arterial layer Paper-thin and composed primarily of endothelial cells Provides a smooth, thrombi-resistant surface and is nourished by the blood flowing through the artery. It is easily damaged by guidewires, catheters or plaque. Atherosclerosis is a disease caused by thickening of the intima. * Explain which type the patient has; note that saccular aneurysms will most likely need to be treated ASAP, regardless of the size. * The first endovascular AAA repair was reported by Dr. Parodi in 1991. We have come a very long way since that initial report. Mortality after endovascular aneurysm repair is approximately 1 to 2 percent, or approximately 1 / 3 that of open surgical repair. For ruptured aneurysms we have made some progress, but clearly not enough: The mortality rate continues to be fairly high at 15-20 percent. The risk of complications, including minor and major types, is 20-30 percent. The risk of lifetime secondary interventions is 10-15 percent. * 术后随访 术后 2周、3月、6月、1年行CTA随访，以后每年一次 护理查房 —腹主动脉瘤 腹主动脉解剖图 Company Logo 腹主动脉瘤概述 腹主动脉瘤是因为动脉中层结构破坏，动脉壁不能承受血流冲击的压力，而形成的局部或者广泛性扩张或膨出，直径>正常50％。临床上把位于肾动脉水平以上的腹主动脉瘤称为胸腹主动脉瘤（5%），位于肾动脉水平以下的称为腹主动脉瘤（95%） 最常见于60—80岁之间的男性 腹主动脉瘤症状体征 多数患者无症状，常因其他原因查体而偶然发现 1、搏动性包块：最典型体征，常位于脐周或左上腹，约50％患者伴有血管杂音。 2、疼痛：为破裂前的常见症状，多位于脐周及中上腹部，为突发的剧烈撕裂样锐痛，不能忍受并呈持续性，病人常伴有窒息感甚至濒死的恐惧 3、破裂症状：面色苍白，手足湿冷，血压骤降，神志逐渐模糊，听诊心音减弱，脉率细速 其他严重并发症：瘤内偶可形成急性血栓。十二指肠受压可发生肠梗阻，下腔静脉阻塞可引起周围水肿。 病例介绍---病情介绍 床号：15