降主动脉缩窄患者行矫正术的手术配合

对20例降主动脉缩窄患者在全麻及体表降温下行矫正术。结果手术均获成功。术后住院10～16d，平均12．7d，均痊愈出院。未发生截瘫、急性肾衰竭等严重并发症，随防1个月至3年，身体发育状况明显改善。提出手术治疗是矫正降主动脉缩窄的有效途径，护士做好术前访视、完善各种应急措施、熟悉手术操作过程，是保障手术配舍默契的关键。     

2例升主动脉合并降主动脉夹层杂交手术的配合

介绍2例采用腔内隔绝术和体外循环下升主动脉人工血管置换术相结合的杂交手术方法治疗升主动脉合并降主动脉夹层的术中护理要点.提出手术室护士熟悉手术过程,术前充分准备,术中默契配合是手术成功的重要因素.     

主动脉缩窄35例的外科治疗

外科治疗主动脉缩窄３５例。年龄６～４２岁，平均２２．７岁。单纯主动脉缩窄３１例，合并ＰＤＡ４例。其中切除缩窄主动脉、端端吻合２０例，涤纶片血管成形术８例，应用人工血管移植术７例。手术死亡率５．７％。我们认为主动脉缩窄段切除端端吻合术的优点为消除动脉导管组织，保留锁骨下动脉和避免应用人工材料。且血管成形术简单安全。     

降主动脉-升主动脉吻合术矫治婴儿期主动脉缩窄合并心内畸形15例

目的探讨降主动脉-升主动脉吻合术治疗婴儿期主动脉缩窄合并主动脉弓发育不良及心内畸形的疗效。方法选取2011-05—2015-05间治疗的主动脉缩窄合并主动脉弓发育不良、心内畸形的患儿15例。患儿均采用胸骨正中切口、开胸后先游离出主动脉弓、头臂干、动脉导管、弓降部等血管。建立体外循环、选择性脑灌注下行降主动脉-升主动脉端侧吻合术,恢复全身灌注后完成心内畸形的矫治。体外循环时间86~132 min,主动脉阻断时间51~94 min。结果术后早期死亡2例,低心排出量综合征6例,室上性心动过速6例,肺炎7例。13例患儿随访2个月~3 a,无死亡及再次主动脉狭窄。结论降主动脉-升主动脉吻合术治疗婴儿期主动脉缩窄合并主动脉弓发育不良及心内畸形的临床效果满意。     

主动脉缩窄合并降主动脉瘤行升-腹主动脉搭桥术后动脉瘤自愈1例

病人　女,4 1岁。头晕、双下肢麻木15年,加重伴胸闷2月余。术前血压:右上肢16 0 5 0mmHg(1mmHg =0 133kPa) ,左上肢及双下肢均为90 70mmHg。磁共振血管造影示主动脉弓降部于左锁骨下动脉分支以近重度缩窄,狭窄以远左锁骨下动脉下方可见一动脉瘤形成,约2 0mm×30mm大小(图1)。因缩窄段累及主动脉弓远端,决定分期手术,先行升主动脉至腹主动脉搭桥术解除缩窄,二期手术切除动脉瘤。2 0 0 3年6月全麻下行升主动脉至腹主动脉搭桥术。胸腹正中联合切口,1 8cm×30cm人工血管经前纵隔及左结肠旁分别与腹主动脉及升主动脉行端侧吻合,开放后上下肢…     

主动脉缩窄手术的麻醉处理

主动脉缩窄手术的麻醉处理王朝仁，张铁铮，王凤学，成凤勤，郑斯聚主动脉缩窄需行手术治疗，在麻醉处理上有一定特殊性。我院１９７４年６月至１９９２年１１月共实施１８例，现将麻醉处理总结如下。临床资料本组１８例中男、女各９例，年龄５～３２岁（１４．６±８．６...     

1例先天性主动脉缩窄致胸主动脉破裂患者的护理

对1例先天性主动脉缩窄致胸主动脉破裂的患者,在深低温体外循环下实施胸主动脉人工血管置换术。术后患者出现心律失常、出血、切口感染、意识障碍和右侧肢体功能障碍等并发症,对其实施严密监护,采取相应的救治,做好心、肺、神经系统护理和基础护理,保证静脉营养供给。结果胸主动脉破裂所致危重状况得到有效控制,患者住院35d痊愈出院。     

婴幼儿主动脉缩窄的外科治疗

目的评价近年来婴幼儿主动脉缩窄（CoA）手术疗效。方法外科治疗118例婴幼儿主动脉缩窄病例。年龄21d～3岁,平均（1．8±1．1）岁;体重2．9～13．5 kg,平均（7．5±2．2）kg。单纯CoA或伴动脉导管未闭（PDA）32例,合并其他心内畸形86例,后者大部分在正中切口深低温停循环（DHCA）或深低温低流量（DHLF）下一期纠治CoA和合并畸形。术中停循环21～48min,平均（32．13±11．72）min。结果因肺高压危象和心律失常死亡2例,病死率1．7％。呼吸机应用11～256 h,平均（98．51±6．68）h。术后随访6～24个月,无神经系统并发症,6例有声音嘶哑,其中5例经正中胸骨切口、1例外侧切口进胸施术。超声检查示2例有残余主动脉缩窄,压力阶差分别为29和36min Hg（1mmHg=0．133 kPa）。结论CoA无论是否合并心内畸形,均主张早期手术,正中切口一期根治术手越来越成为首选方案;主动脉远端与主动脉弓下缘广泛端端吻合术（EEEA）等手术方法的应用扩大了手术根治的指征,也提高了术后疗效。     

主动脉缩窄手术时上下肢血压的同步监测与控制

本文报告全麻下主动脉缩窄手术３５例，其中前１０例应用浅低温，后２５例改用常温。全组麻醉后行右侧桡动脉和右股动脉穿刺置管，同步监测术中挠动脉平均压（ＲＡＰ）与股动脉平均压（ＦＡＰ）的变化。为了防止降主动脉阻断期间上半身出现严重高血压和出血危险，本组采用了控制性低血压，使阻断期间ＲＡＰ不高于１２～１３ｋｐａ（９０～１００ｍｍＨｇ）。但为了防止下半身血压过低，ＦＡＰ最好不低于５．３～６．７ｋＰａ（４０～５０ｍｍＨｇ）。本文提示在主动脉缩窄根治术时实施上下肢血压的同步监测与调控，不仅有利于对上下肢血压梯度的了解，判定手术效果，还有助于防止并发症，尤其是肾和脊髓的缺血损伤。     

Correction of Aortic Coarctation

Experiments performed in the 1930s demonstrated the results of cross-clamping the aorta in animals. Findings from these experiments permitted cross-clamping of the aorta both above and below the origin of the ductus, in a series of ductus Botalli cases. This experience in turn led to the decision to perform a radical operation for coarctation of the aorta by placing clamps above and below the coarctation, removing the clamps, and sewing the aorta end-to-end. The first coarctation resection was performed on October 19, 1944.A total of 216 operations for aortic coarctation were performed from 1944 to January, 1958. In the last 180 patients, use of a continuous, everting end-to-end suture practically excluded complications from the suture. With this technique there were few complications and a primary mortality not exceeding 6%.     

Simultaneous Correction of Aortic Coarctation and Partial Anomalous Pulmonary Venous Return

A 23-year-old asymptomatic woman with aortic coarctation and anomalous drainage of the right inferior and left pulmonary veins underwent correction. Coarctation repair was followed by anastomosis of the anomalous vertical vein to the left atrium under femoral-femoral bypass. A left thoracotomy offered excellent exposure for simultaneous repair of this unusual combination of vascular anomalies.     

主动脉缩窄合并心内畸形的一期手术治疗

１９９３年６月至１９９４年８月为５例主动脉缩窄合并先天性心内畸形病儿施行了一期手术治疗。男４例，女１例，年龄１．５～１３岁，体重７．５～４５ｋｇ。除主动脉缩窄外，合并的心内畸形有室间隔缺损、主动脉瓣及瓣下狭窄、主动脉瓣关闭不全等。手术采用左后外侧第４肋间切口，矫治主动脉缩窄后，同期行胸骨正中切口体外循环下心内畸形矫治。本组无手术死亡和并发症，取得了满意的治疗效果。作者认为，对主动脉缩窄合并心内畸形施行一期手术矫治是完全可行的。     

Reoperation for Aortic Coarctation

Reoperation for aortic coarctation has become common because of several factors: (1) increased physician awareness that hypertensive cardiovascular disease continues to threaten the prognosis of the patient following coarctectomy and that investigation in some symptomatic individuals after coarctectomy will demonstrate a residual or recurrent coarctation, even many years after the primary repair; (2) the widespread application of stress testing, which can reveal marked arm-to-leg pressure gradients not observed at rest, to the routine postcoarctectomy follow-up examination; (3) improved noninvasive aortic evaluation techniques, such as ultrasound; and (4) higher salvage rates among infants undergoing urgent coarctation repairs and the recognition that these children subsequently are at high risk for recoarctation.A surgical decision-making process characterized by flexibility provides maximum patient safety; no single reoperation technique can be applied in all situations. Individual circumstances may dictate recoarctation repair by resection with end-to-end anastomosis, tube graft interposition, aortoplasty, or tube graft bypass. The need for a temporary aortic shunt or partial left atriofemoral bypass to maintain adequate distal aortic perfusion pressure during the repair means that these methods must be available at all reoperations. Diligent efforts to repair all hemodynamically significant residual and recurrent coarctations are necessary if the natural fate of premature death is to be avoided for patients with these lesions.     

1例急性会厌炎并急性肺水肿的护理

对1例先天性主动脉缩窄致胸主动脉破裂的患者，在深低温体外循环下实施胸主动脉人工血管置换术。术后患者出现心律失常、出血、切口感染、意识障碍和右侧肢体功能障碍等并发症，对其实施严密监护，采取相应的救治，做好心、肺、神经系统护理和基础护理，保证静脉营养供给。结果胸主动脉破裂所致危重状况得到有效控制，患者住院35d痊愈出院。