Acute myocardial infarction and arterial embolectomy

Emboli of a main artery cause serious complications in patients suffering from acute myocardial infarction, in whom the surgical risk is high. In order to save the limb, embolectomy is indicated and should be considered. Early diagnosis and prompt surgical intervention with the use of the Fogarty catheter simplify the embolectomy procedure and enable restoration of circulation to the ischaemic limb. Thirty-two embolectomies were performed in twenty-eight patients suffering from acute myocardial infarction. Patients with cardiac compensation survived the surgery and recovered. However 50% of the patients in whom acute myocardial infarction was accompanied with congestive heart failure and arrhythmias died. The cause of death was the underlying disease. Considering the severity of the acute myocardial infarction this group of patients represents the expected mortality.     

Massive pulmonary embolism: the place for embolectomy

Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice.     

Fogarty导管取栓术27例的临床诊治及分析

目的 探讨Fogarty导管取栓术的临床诊治.方法 对27例Fogarty导管取栓术的治疗及效果分析.结果 12例为急性动脉栓塞病例,手术取栓加溶栓、抗凝、解痉药物治疗效果好,无围手术期死亡病例,并发症少.15例为急性血栓形成病例,术前溶栓效果较好,手术取栓完全.但多伴有动脉硬化斑块形成,术后加用球囊扩张和(或)支架后较少复发,无围手术期死亡病例,并发症少.结论 Fogarty导管取栓术风险小,操作简单,疗效确切.     

主动脉夹层与主动脉瘤手术的临床麻醉分析

目的:回顾性分析总结主动脉夹层与主动脉瘤外科手术的麻醉实施方案及重要脏器的保护方法。方法:分析33例行升主动脉替换、全弓替换加支架象鼻手术患者的麻醉方法以及术中监测、循环管理、内环境调控和脑、肾、血液保护的情况。结果:本组病例中,平均体外循环时间(245±49)min,术中平均失血量(2150±820)ml,平均输库血量(1870±490)ml。2例病人术后1周内有轻微神经系统症状,2例病人合并有急性肾功能衰竭,1例心包填塞行二次开胸止血,1例术后发生急性心肌梗死,并发症发生率18.1%。本组共有3例病人在术后早期死亡,死亡率9.9%。本组病例无麻醉死亡.结论:动脉夹层与主动脉瘤手术的麻醉应着重强调麻醉诱导及维持的平稳,循环功能的稳定,脑、肾、血液保护和机体内环境的平衡。