脑血管疾病颈动脉内膜切除术的麻醉管理(双语).ppt

AnestheticManagementofCerebrovascularDiseaseCarotidEndarterectomy;Introduction;Majorsymptomsofcarotidarterydiseaseincludechangesinvision,headache,changesinspeech,orfacial(发热)andextremity(四肢)weakness.Signs(体征)suggestiveofcarotidarterydiseaseincludeahigh-pitchedbruit(高亢的杂音)attheorigin(起源)oftheinternalcarotidartery,increaseinsizeandpulsation（强度）oftheipsilateral(同侧)superficialtemporalartery（颞浅动脉）,andchangesintheretinalexamination（眼底检查）.Confirmation（确诊）ofcarotidarterydiseaseisachievedbyvascularimagingwhichmayincludeultrasound,MRangiography,orcatheterangiography.（颈动脉疾病的确认是通过血管成像，其中可能包括超声，磁共振血管造影或导管造影）;Introduction;CarotidArteryRevascularization（颈动脉再灌注）

;Anatomic/Physiologic（解剖/生理学）Considerations;;Otherfactorswhichhavebeenreportedtoincreaseneurologicalriskinclude:（其他有报道的增加神经系统风险的因素包括）;Medicalcomplicationsoccurabout10%ofthetimeafterCEAandareassociatedwiththefollowing:（CEA后并发症的发生还与下列有关）;Monitoring（监控）;Monitoring（监控）;;Monitoring（监控）;AnestheticManagement;AnestheticManagement;AnestheticManagement;ModalitiesofCerebralProtection

脑保护的方式;;2.Hyperglycemia（高血糖）-shouldbeavoided（避免）andtreated（处理）whenpossible.

3.Hypertension（高血压）-duringischemia,autoregulation（自动调节）isimpairedandCBFisdependentonperfusionpressure（灌注压）.Itisadvisabletomaintainnormaltohigharterialpressureinmostsituations.（缺血过程中，自动调节受损，脑血流是依赖于灌注压力以维持正常的动脉血压，在大多数情况下，这是可取的）

4.Hemodilution（血液稀释）-usinghemodilutiontoimproveCBFisdependentupontherationale（原理）thatCBFisinverselyrelatedto（负相关的）hematocrit（血细胞比容）.（使用血液稀释改善CBF是根据CBF负相关于血细胞比容的原理）

5.CarbonDioxide（二氧化碳）-normocarbia（正常二氧化碳分压）shouldbethegoal.（必须维持正常的二氧化碳分压）

;ModalitiesofCerebralProtection

;;6.Bleeding-airwayobstructionhasbeenattributedtoneckhematomathatisworsenedbyhypertension.（气道阻塞已被归因于高血压恶化导致的颈部血肿）

7.CranialNerveInjury-Damagetotherecurrentlaryngealnervemaycompromiseprot