全凭吸入麻醉在45例主动脉夹层动脉瘤介入手术中的应用

目的 观察喉罩通气全凭七氟醚吸入麻醉下行主动脉夹层动脉瘤介入术患者血流动力学变化及术后恢复情况.方法 选择45例行主动脉夹层动脉瘤介入手术的患者,行喉罩通气全凭七氟醚吸入麻醉,观察患者麻醉诱导前、置入喉罩后、手术中、拔除喉罩后的SPO2 、PrTCO2和动脉血气值,并观察术中、术后患者的血流动力学波动.结果 麻醉前后S...     

主动脉手术的麻醉

主动脉手术,是指从主动脉根部至髂动脉范围内的主动脉手术,其原发病主要包括主动脉夹层动脉瘤、真性动脉瘤、假性动脉瘤、大动脉炎、主动脉溃疡和主动脉外伤等.随着国人高血压、糖尿病、动脉粥样硬化发病率的增高及医务人员认知和诊断水平的提高,主动脉手术病例呈快速增长的趋势.做好手术麻醉,可对保证手术质量起到重要的作用.本文主要探讨主动脉手术的麻醉问题.     

剖宫产术前行腹主动脉球囊导管预置术对凶险型前置胎盘合并胎盘植入孕妇及胎儿的影响

目的 探讨剖宫产术前行腹主动脉球囊导管预置术对凶险型前置胎盘合并胎盘植入孕妇及其胎儿的影响.方法 选取2015年1月—2017年1月川北医学院附属医院收治的66例凶险型前置胎盘合并胎盘植入66例,按是否行腹主动脉球囊导管预置术分为观察组与对照组,每组33例.观察组于剖宫产术前行腹主动脉球囊导管预置术,术中充盈球囊临时阻断主动脉血流;对照组未行腹主动脉球囊导管预置术.分析2组术中、术后及胎儿情况.结果 观察组手术时间和凝血酶原时间短于对照组,术中输血量和出血量少于对照组(P<0.05).观察组住院天数短于对照组,ICU转入率低于对照组(P<0.05).2组新生儿Apgar评分和出生体质量比较差异无统计学意义(P>0.05).结论 剖宫产前对凶险型前置胎盘合并胎盘植入孕妇行腹主动脉球囊导管预置术,可以完成剥离胎盘及子宫修补术,减少术中出血量,降低子宫切除率.     

胎儿主动脉缩窄的产前超声诊断及预后评估

目的：探讨产前超声诊断胎儿主动脉缩窄的价值和预后评估。方法回顾分析了本院19例主动脉缩窄胎儿的CDFI声像图特点及随访跟踪检查CDFI声像图变化情况。结果19例主动脉缩窄胎儿中,12例合并心内畸形,其中3例伴室间隔缺损,2例合并右心室双出口,2例完全性肺静脉异位引流,1例动脉导管瘤样扩张,1例大动脉完全转位,1例单心室,1例完全性心内膜垫缺损,1例合并复杂心内畸形;2例合并心外畸形,其中1例合并胸腹水,1例伴足内翻;5例为单纯性主动脉缩窄,其中1例误诊为主动脉弓离断,2例随诊狭窄程度加重,2例漏诊胎儿出生后检出,后经手术矫治,预后良好。结论产前超声诊断对胎儿主动脉缩窄及预后评估具有重要的临床价值。     

急性主动脉夹层的手术治疗研究

目的总结"升主动脉+主动脉弓替换+远端硬象鼻置入术"在"急性主动脉夹层"救治中的临床经验。方法对本院2012年1月至2014年1月13例急性主动脉夹层(Standford A/B)患者实施升主动脉+主动脉弓替换+远端硬象鼻置入术,手术均在全麻深低温停循环顺行性脑灌注下完成,均采用胸正中切口,手术先行升主动脉替换/Bentall手术,然后行硬象鼻支架弓降部置入,最后以直筒人工血管或四分支人工血管吻合于远近人工血管之间,形成弓部替换,弓顶开窗与无名动脉、左颈总动脉、左锁骨下动脉开口形成分流。结果13例中,1例死亡,12例患者观察2~24个月,无死亡及再手术病例。结论升主动脉+主动脉弓替换+远端硬象鼻置入术能有效救治急性主动脉夹层患者生命,是治疗的重要方法。     

小儿主动脉缩窄矫治术的麻醉处理

目的总结和探讨25例小儿主动脉缩窄矫治手术的麻醉处理特点。方法2004年1月至2008年12月收治25例主动脉缩窄患者,全部在全麻气管内插管、控制性降压及低温下行主动脉缩窄矫治术。采用芬太尼为主的静吸复合全麻,麻醉中同时监测右上肢和下肢血压,并应用微量泵静注硝酸甘油或硝普钠控制性降压。结果手术前及阻断主动脉前上肢收缩压维持在90-130min Hg,下肢收缩压60-70mm Hg,上下肢血压差异20-40mm Hg以上。阻断主动脉时间26-78min。阻断主动脉期间上肢收缩压波动在65-105mm Hg之间,下肢收缩压35-58mm Hg。开放主动脉后上肢血压无明显降低,下肢较上肢低10-15mm Hg。全组未发生与麻醉相关的并发症。结论小儿主动脉缩窄患者虽然也出现上肢高血压,但血压升高的程度不严重,其麻醉处理重点在于选择合适的麻醉方式、恰当的做好控制性降压和适当的降温,严防各种并发症的发生。     

非体外循环下主动脉缩窄手术的麻醉探讨

目的 总结和探讨主动脉缩窄手术的麻醉管理方法.方法 11例降主动脉缩窄患者在控制性降压和浅低温非体外循环全麻下行主动脉缩窄矫治术,麻醉采用气管插管芬太尼为主的静脉全身麻醉,术中同时监测上、下肢血压,应用硝普钠控制性降压.结果 本组11例患者平均阻断时间为23min,平均温度34.5℃,术中收缩压维持一定水平,术后平均拔管时间3.5h.全组无严重心律失常、重要脏器损害及截瘫等严重并发症.结论 适当低温、实施控制性降压,维护血流动力学平稳,积极预防并发症是主动脉缩窄手术麻醉成功的关键.     

覆膜支架介入治疗主动脉夹层动脉瘤的麻醉体会

目的：探讨覆膜支架介入治疗主动脉夹层动脉瘤的麻醉处理及注意事项。方法：对25例DeBakeyⅢ型主动脉夹层动脉瘤患者应用覆膜血管支架植入技术治疗。术前予以积极控制性降压、防止感染等手段,术中应全身麻醉,通过介入方法植入覆膜支架,术后注意陪护预防并发症且及时建立术后镇痛。结果：25例患者最终成功完成覆膜血管支架植入手术。麻醉时间为（120±25）min,手术时间为（90±18）min,术中失血量为（155±50）ml,收缩压为86～118mmHg。术后患者清醒快,无烦躁不安,顺利拔管。结论：在覆膜支架介入治疗主动脉夹层动脉瘤的手术过程中选择全身麻醉方式效果显著。     

腔内隔绝术治疗胸主动脉夹层的麻醉处理

治疗胸主动脉夹层的传统手术方式是开胸进行人工血管置换,麻醉时需要采用单肺通气以避免左侧正常通气的肺影响手术操作.作为一种替代治疗方法,腔内隔绝术治疗胸主动脉夹层具有疗效确切、应激反应轻、并发症少及术后恢复快等优点,但同时其麻醉处理也具有较大风险.我院2004年4月-2010年6月收治胸主动脉夹层患者53例,均采用静吸复合气管插管麻醉行腔内隔绝术,效果良好,现将麻醉处理报道如下.     

成人型主动脉完全闭锁的外科治疗

1994年 7月～ 1999年 6月 ,我科为 3例成人型主动脉完全闭锁的患者行手术治疗 ,现报告如下。临床资料例 1,男 ,39岁。因活动后胸闷、心慌 1个月入院。双上肢血压 16 0 /10 0ｍｍＨｇ ,下肢血压测不清 ,足背动脉搏动未触及。左肩胛与脊柱间闻及 3/6级收缩期杂音。胸片示肋骨下缘有压迹。核磁共振示主动脉峡部中断 ,管腔闭锁长为2ｃｍ。逆行主动脉造影 ,导管不能通过弓降部 ;升主动脉造影示峡部闭锁 ,侧枝血管迂曲、扩张。于 1994年 7月 4日在全身麻醉常温下左侧开胸 ,术中监测桡动脉及股动脉压力。术中见主动脉峡部闭锁长 2ｃｍ ,侧枝动脉血…     

Tetrahydrobiopterin Inhibits PDGF-stimulated Migration and Proliferation in Rat Aortic Smooth Muscle Cells via the Nitric Oxide Synthase-independent Pathway

Tetrahydrobiopterin (BH4), an essential cofactor for nitric oxide synthase (NOS) activity, is known to play important roles in modulating both NO and superoxide production during vascular diseases such as atherosclerosis. However, the role of BH4 in functions of vascular smooth muscle cells is not fully known. In this study, we tested the effects of BH4 and dihydrobiopterin (BH2), a BH4 precursor, on migration and proliferation in response to platelet-derived growth factor-BB (PDGF-BB) in rat aortic smooth muscle cells (RASMCs). Cell migration and proliferation were measured using a Boyden chamber and a 5-bromo-2''-deoxyuridine incorporation assay, respectively, and these results were confirmed with an ex vivo aortic sprout assay. Cell viability was examined by 2,3-bis [2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide assays. BH4 and BH2 decreased PDGF-BB-induced cell migration and proliferation in a dose-dependent manner. The inhibition of cell migration and proliferation by BH4 and BH2 was not affected by pretreatment with N^G-nitro-L-arginine methyl ester, a NOS inhibitor. Moreover, the sprout outgrowth formation of aortic rings induced by PDGF-BB was inhibited by BH4 and BH2. Cell viability was not inhibited by BH4 and BH2 treatment. The present results suggest that BH4 and BH2 may inhibit PDGF-stimulated RASMC migration and proliferation via the NOS-independent pathway. Therefore, BH4 and its derivative could be useful for the development of a candidate molecule with an NO-independent anti-atherosclerotic function.     

Finasteride use during pregnancy and early neonatal outcome: a case report

The use of antiandrogen drugs such as finasteride during pregnancy may carry the risk of birth defects, especially hypospadias. We report a 39-year-old woman, with 5 weeks unplanned pregnancy, the patient conceived while receiving daily dose of finasteride 2.5 mg for treatment of alopecia. The patient’s partner was concurrently using finasteride for the same purpose. Ultrasound scans including detailed anatomy were normal throughout pregnancy and the fetal gender was detected to be male. The patient had her delivery at 38⁺⁵ weeks’ gestation, by elective cesarean section, a male infant with a weight of 3.58 kg and Apgar score of 9 and 10 at 1 and 5-min, respectively. The infant was healthy with no obvious dysmorphic features. In this case report, maternal use of finasteride in early pregnancy was not associated with external genitalia abnormalities of a male baby. Moreover, maternal exposure to the semen of partner who received finasteride did not adversely affect the short term neonatal outcomes. However, absence of apparent neonatal adverse effects in a single case report does not indicate safety of use. Population-based long term neonatal outcomes are yet to be established.     

Aortic root reconstruction by aortic valve-sparing operation (David type I reimplantation) in Marfan syndrome accompanied by annuloaortic ectasia and acute type-A aortic dissection

To reconstruct the aortic root for aneurysm of the ascending aorta accompanied by aortic regurgitation, annuloaortic ectasia (AAE) and acute type-A dissection with root destruction, the Bentall operation using a prosthetic valve still is the standard procedure today. Valve-sparing procedures have actively been used for aortic root lesions, and have also been attempted in aortic root reconstruction for Marfan syndrome which may have abnormalities in the valve leaflets. We conducted a valve-sparing procedure in a female patient with Marfan syndrome who had AAE accompanied by type-A acute aortic dissection. The patient was a 37-year-old woman complaining of severe pain from the chest to the back. The limbs were long, and funnel breast was observed. Diastolic murmurs were heard. On chest computed tomography, a dissection cavity was present from the ascending aorta to the left common iliac artery, and the root dilated to 55 mm. Grade II aortic regurgitation was observed on ultrasound cardiography. Regarding her family history, her father had died suddenly at 54 years of age. She was diagnosed with type-A acute dissection concurrent with Marfan syndrome and AAE. The structure of the aortic valve was normal, and root reconstruction by a valve-sparing operation and total replacement of the aortic arch was conducted. On postoperative ultrasound cardiography, the aortic regurgitation was within the allowable range, and the shortterm postoperative results were good.     

拉贝洛尔和尼卡地平治疗主动脉夹层时高血压的疗效比较

目的:评估静脉应用拉贝洛尔或尼卡地平治疗主动脉夹层时高血压的疗效及安全性。方法:60例主动脉夹层伴高血压者随机接受拉贝洛尔或尼卡地平治疗。结果:治疗10min平均动脉压下降10%~15%者,拉贝洛尔组为38%,尼卡地平组为45%(P>0.05);30min后血压控制在120/80mmHg以下者,拉贝洛尔组为93%,尼卡地平组为90%(P>0.05);治疗后10min平均心率下降拉贝洛尔组((77±7)次.min-1)较尼卡地平组((83±10)次.min-1)明显(P<0.05)。结论:拉贝洛尔或尼卡地平均可有效控制主动脉夹层时血压,拉贝洛尔单独静脉使用较尼卡地平单用更适合此临床急症。     

蛇床子素对家兔主动脉条的钙拮抗作用

蛇床子素30μmol·L~(-1)及100μmol·L~(-1)使NE、CaCl_2和高K~+除极化所致的家兔主动脉条收缩量—效曲线右移,最大反应降低.表明蛇床子素有松弛血管平滑肌作用,并与Ca~(2+)呈非竞争性拮抗作用.和阻滞α受体或激动β受体无关;选择性作用于电位依赖性Ca~(2+)通道,抑制细胞外Ca~(2+)内流;在100μmol·L~(-1)时,明显减弱NE诱导的依赖细胞内Ca~(2+)收缩。证明蛇床子素松弛血管平滑肌作用可能与其Ca~(2+)拮抗作用有关。     

瓜蒌提取物对离体家兔胸主动脉条收缩的影响

以兔离体主动脉条为实验材料,观察ＥＦＴ对去甲肾上腺素（ＮＥ）、氯化钾（ＫＣｌ）和氯化钙（ＣａＣｌ２）的剂量－效应曲线的影响及主动脉条的α受体及β受体的作用．观察了ＥＦＴ对ＮＥ引起的兔主动脉条２种收缩成分的影响．结果ＥＦＴ能舒张已被氯化钙、高钾和去甲肾上腺素收缩的兔主动脉条,使ＮＥ、ＫＣｌ、ＣａＣｌ２的剂量－效应曲线非平行右移,最大效应降低．ＥＦＴ松驰血管平滑肌的作用不依赖于阻断α受体或β受体．而与戊脉安（Ｖｅｒ）相似,是通过阻断钙通道实现的．但它们阻断钙通道的方式不同．ＥＦＴ可能无选择性阻断电位依赖性钙通道和受体操纵性钙通道,而Ｖｅｒ则只选择性阻断．因此,ＥＦＴ的扩血管机制与其对钙通道阻断作用有关     

Lead Induces Endothelium‐ and Ca2+‐Independent Contraction in Rat Aortic Rings

Abstract: The contractile effect of lead on rat aortic rings was examined. Lead (0.1–3.1 mM) elicited concentration‐dependent but endothelium‐independent contractions, which were unaffected by prazosin (1 μM). The contractile effects of lead were similar when the aortic rings were bathed either in the absence or presence of external Ca²⁺. Lanthanum (1 mM) but not verapamil (1 μM) inhibited the lead contractions; hence non‐L‐calcium channels are involved in such effect. In addition, lead induced contractions on aortic rings incubated in Ca²⁺‐free EGTA‐containing solution for 70 min., an experimental condition in which intracellular Ca²⁺‐stores are depleted. Finally, the contractile effect of lead was not modified by calphostin C (an inhibitor of protein kinase C). In conclusion, the present results suggest that in rat aorta, the lead‐induced contraction is independent of extra‐ and intracellular calcium stores. In addition, the effect of lead is independent of either catecholamines or protein kinase C. It is likely that in rat aorta, lead enters into the smooth muscle cells through non‐L‐calcium channels, and when acting like calcium on the contractile machinery it produces contraction. The differences observed between our results and those obtained by other authors may indicate that the mechanism of the contractile effect of lead varies among the different blood vessels.     

新型三分支主动脉弓覆膜支架治疗Ⅰ型主动脉夹层的研究

目的利用一种全新的三分支型主动脉弓覆膜支架治疗Ⅰ型主动脉夹层,并进行疗效评价。方法自2006年6月至2009年8月,50例Ⅰ型主动脉夹层病人接受手术治疗。病人分为：I组（n=25）接受支架＂象鼻＂手术,和II组（n=25）接受新型分支型支架手术。结果Ⅱ组病人手术时间、体外循环时间、心脏阻断时间、停循环时间及术中出血量均低于Ⅰ组,差异均有显著性。两组病人手术死亡率、病人一过性脑损伤发生率比较,差异无显著性。两组病人术后短期随访恢复良好。结论采用三分支主动脉弓覆膜支架治疗Ⅰ型主动脉夹层,与目前应用的支架＂象鼻＂技术比较,简化了主动脉弓部手术,降低了手术风险,适合于大多数Ⅰ型主动脉夹层病人的治疗,其长期效果尚需进一步观察。     

手术治疗主动脉窦瘤破裂临床分析

目的回顾性分析37例主动脉窦瘤破裂的外科治疗。方法主动脉窦瘤修补15例直接缝合,22例用涤纶片修补内破口;行主动脉瓣置换术9例,主动脉瓣成形术3例;VSD直接缝合4例,补片修补15例。结果全组死亡1例。35例随访6个月~5年,无残余分流等并发症,心功能恢复良好。结论主动脉窦瘤破裂一经确诊,应尽早手术,预后良好。对于严重主动脉瓣关闭不全,应同期行主动脉瓣置换术或主动脉瓣成形术。     

Acebrophylline-induced angioedema

A 53-year-old woman visited her physician complaining of acute breathlessness and productive cough. Her medications included budesonide and formoterol for asthma, fixed-dose combination aspirin 150 mg + clopidogrel 75 mg + atorvastatin 20 mg for ischemic heart disease. History revealed that she had allergic rhinitis and was hypersensitive to penicillins. The patient was prescribed acebrophylline (ABP). Six hours after ABP therapy she presented with generalized urticarial lesions, swelling of hands, feet, lips and face, suggestive of angioedema. ABP was stopped immediately, and the patient was treated symptomatically. This case was categorized as probable as per standard causality assessment scale.KEY WORDS: Allergic, de-challenge, Naranjo''s scale, urticarial lesions