动脉瘤患者动脉瘤破裂所致的蛛网膜下腔出血(SAH)是一种严重威胁患者的生命的急症。该病发生后需要立即进行手术对动脉瘤予以处理,防止继发性出血。但40%的患者手术后仍然会由于脑血管痉挛(CVS)导致迟发性脑缺血(DCI),由于残余脑损伤导...动脉瘤患者动脉瘤破裂所致的蛛网膜下腔出血(SAH)是一种严重威胁患者的生命的急症。该病发生后需要立即进行手术对动脉瘤予以处理,防止继发性出血。但40%的患者手术后仍然会由于脑血管痉挛(CVS)导致迟发性脑缺血(DCI),由于残余脑损伤导致患者预后不佳。目前对于该类患者预后判定的最佳工具即患者入院时的世界神经外科联合学会(World Federation of Neurosurgical Societies,WFNS)评级或Hunt及Hess量表[1]。但该病的病理生理过程及血管外血量与动脉收缩的关系仍不明确。展开更多
Objective Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mech...Objective Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mechanical dyssynchrony and increasing energy efficiency. MethodsNine patients with left ventricular postinfarction aneurysm were studied intraoperatively before and after ventricular restoration with a conductance volume catheter to analyze pressure-volume relationships, energy efficiency, and mechanical dyssynchrony. The end-systolic elastance was used as a load-independent index of contractile state. Left ventricular energy efficiency was calculated from stroke work and total pressure-volume area. Segmental volume changes perpendicular to the long axis were used to calculate mechanical dyssynchrony. Statistical analysis was performed with the paired t test and least-squares linear regression. Results Endoventricular patch aneurysmectomy reduced end-diastolic volume by 37%(P < .001), with unchanged stroke volume. Systolic function improved, as derived from increased +dP/dtmax, by 42%(P < .03), peak ejection rate by 28%(P < .02), and ejection fraction by 16%(P < .0002). Early diastolic function improved, as shown by reduction of-dP/dtmax by 34%(P < .006)and shortened τby 30%(P< .001). Left ventricular end-systolic elastance increased from 1.2±0.6 to 2.2±1 mm Hg/mL(P < .001). Left ventricular energy efficiency increased by 36%(P < .002). Left ventricular mechanical dyssynchrony decreased during systole by 33%(P < .001)and during diastole by 20%(P < .005). Conclusions Left ventricular restoration induced acute improvements in contractile state, energy efficiency, and relaxation, together with a decrease in left ventricular mechanical dyssynchrony.展开更多
目的研究和分析弹簧圈介入栓塞术治疗颅内动脉瘤患者的全麻护理体会。方法回顾性分析我院2015年4月—2017年4月收治的64例颅内动脉瘤患者实施弹簧圈介入栓塞术治疗全麻护理过程,麻醉过程中,细致观察患者的体征变化,如出现并发症及时做...目的研究和分析弹簧圈介入栓塞术治疗颅内动脉瘤患者的全麻护理体会。方法回顾性分析我院2015年4月—2017年4月收治的64例颅内动脉瘤患者实施弹簧圈介入栓塞术治疗全麻护理过程,麻醉过程中,细致观察患者的体征变化,如出现并发症及时做好正确处理,保证手术正常进行,并在麻醉后密切关注患者的意识恢复情况,探查患者是否存在相应的神经障碍问题。结果治疗成功概率为100%,在手术的过程中1例患者出现动脉瘤破裂情况,2例患者的术中脑血管痉挛,经过填塞动脉瘤和抗血管痉挛治疗之后,患者的没有不适症状。有63例患者的收缩压在85~110 mm Hg之间,只有1例肿瘤破裂的患者收缩压为180 mm Hg以上。结论在对颅内动脉瘤实施弹簧圈介入栓塞术中,运用全麻护理效果显著,减少手术时间,减少麻醉用药时间,缩短手术时间。展开更多
文摘动脉瘤患者动脉瘤破裂所致的蛛网膜下腔出血(SAH)是一种严重威胁患者的生命的急症。该病发生后需要立即进行手术对动脉瘤予以处理,防止继发性出血。但40%的患者手术后仍然会由于脑血管痉挛(CVS)导致迟发性脑缺血(DCI),由于残余脑损伤导致患者预后不佳。目前对于该类患者预后判定的最佳工具即患者入院时的世界神经外科联合学会(World Federation of Neurosurgical Societies,WFNS)评级或Hunt及Hess量表[1]。但该病的病理生理过程及血管外血量与动脉收缩的关系仍不明确。
文摘Objective Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mechanical dyssynchrony and increasing energy efficiency. MethodsNine patients with left ventricular postinfarction aneurysm were studied intraoperatively before and after ventricular restoration with a conductance volume catheter to analyze pressure-volume relationships, energy efficiency, and mechanical dyssynchrony. The end-systolic elastance was used as a load-independent index of contractile state. Left ventricular energy efficiency was calculated from stroke work and total pressure-volume area. Segmental volume changes perpendicular to the long axis were used to calculate mechanical dyssynchrony. Statistical analysis was performed with the paired t test and least-squares linear regression. Results Endoventricular patch aneurysmectomy reduced end-diastolic volume by 37%(P < .001), with unchanged stroke volume. Systolic function improved, as derived from increased +dP/dtmax, by 42%(P < .03), peak ejection rate by 28%(P < .02), and ejection fraction by 16%(P < .0002). Early diastolic function improved, as shown by reduction of-dP/dtmax by 34%(P < .006)and shortened τby 30%(P< .001). Left ventricular end-systolic elastance increased from 1.2±0.6 to 2.2±1 mm Hg/mL(P < .001). Left ventricular energy efficiency increased by 36%(P < .002). Left ventricular mechanical dyssynchrony decreased during systole by 33%(P < .001)and during diastole by 20%(P < .005). Conclusions Left ventricular restoration induced acute improvements in contractile state, energy efficiency, and relaxation, together with a decrease in left ventricular mechanical dyssynchrony.
文摘目的研究和分析弹簧圈介入栓塞术治疗颅内动脉瘤患者的全麻护理体会。方法回顾性分析我院2015年4月—2017年4月收治的64例颅内动脉瘤患者实施弹簧圈介入栓塞术治疗全麻护理过程,麻醉过程中,细致观察患者的体征变化,如出现并发症及时做好正确处理,保证手术正常进行,并在麻醉后密切关注患者的意识恢复情况,探查患者是否存在相应的神经障碍问题。结果治疗成功概率为100%,在手术的过程中1例患者出现动脉瘤破裂情况,2例患者的术中脑血管痉挛,经过填塞动脉瘤和抗血管痉挛治疗之后,患者的没有不适症状。有63例患者的收缩压在85~110 mm Hg之间,只有1例肿瘤破裂的患者收缩压为180 mm Hg以上。结论在对颅内动脉瘤实施弹簧圈介入栓塞术中,运用全麻护理效果显著,减少手术时间,减少麻醉用药时间,缩短手术时间。
