体外循环后血管麻痹综合征

自从体外循环 (ＣＰＢ)问世以来 ,ＣＰＢ对机体产生的不良影响越来越受到人们的关注 ,包括不同程度肺、肾功能不全、出、凝血功能紊乱、白细胞激活氧自由基释放、全身非特异性炎性反应、发热和血管收缩等〔1〕 。近年来 ,一种脱离ＣＰＢ后早期出现的、以严重低血压伴血流动力学高排低阻为特征、类似脓毒血症暖休克变化的新现象———血管麻痹综合征(ｖａｓｏｐｌｅｇｉｃｓｙｎｄｒｏｍｅ) 〔2〕 ,又称血管扩张性休克 (ｖａｓｏｄｉｌａｔｏｒｙｓｈｏｃｋ) 〔3〕 ,简称ＶＳ ,引起了临床医师的重视。ＶＳ的概念〔2 - 5〕由于研究方法和研究…     

血管麻痹综合征麻醉管理一例

患者,男,64岁,59kg,1999年曾在体外循环下行冠状动脉搭桥术(CABG),术中应用抑肽酶500万kIU;术后症状缓解,服药治疗。近半年再次出现心绞痛症状,活动明显受限,于2004年5月15日入院。冠状动脉造影提示：桥血管未见显影,冠状动脉三支病变。左室造影示：广泛性室壁运动减弱,射血分数(EF)34.7％。入院诊断：冠状动脉粥样硬化性心脏病,CABG术后,不稳定性心绞痛,心功能(NYHA分级)Ⅲ级,高血压病3级,Ⅱ型糖尿病。内科应用硝酸甘油、卡托普利、倍他乐克等药,行扩冠、降压、降糖、降脂综合治疗。6月9日行二次CABG,在全麻、浅低温(鼻温最低32℃)、体外循环下,于前降支和后降支搭两支静脉桥。     

冠状动脉旁路移植术后血管麻痹综合征的易发因素

目的探讨冠状动脉旁路移植术(CABG)后血管麻痹综合征的易发因素。方法24例CABG后发生血管麻痹综合征的患者,同时选入48例术后未发生血管麻痹的患者以1∶2的比例行病例对照研究。结果麻痹组术前左室射血分数(LVEF)<45%的占50.0%,明显高于对照组的10.4%(P<0.01);左室舒张末前后径(LVEDD)也明显大于对照组[(56.78±7.20)vs.(52.80±6.74)mm](P<0.05)。结论术前低LVEF(<45%)是CABG后血管麻痹综合征的易发因素。     

冠状动脉旁路移植术后并发血管麻痹综合征患者的监护

对13例冠状动脉旁路移植术后并发血管麻痹综合征患者,及时应用大剂量血管收缩药物,维持水、电解质及酸碱平衡等治疗,10例治愈,2例死亡,1例自动出院。提出严密血流动力学和多器官功能监护,及时准确诊断,尤其注意与低心排综合征及血容量不足的鉴别,可改善患者预后,提高手术成功率。     

格林-巴利综合征合并球麻痹呼吸肌麻痹患者的护理

我院１９８６～１９９７年共收治成人格林巴利综合征（ＧＢＳ）１１０例。其中合并球麻痹呼吸肌麻痹５３例,１９例行气管切开使用呼吸机辅助呼吸,死亡７例,为住院病例的６３６％（７／１１０）,占球麻痹呼吸肌麻痹病死率的１３２１％（７／５３）,比文献报道［...     

手法治愈梨状肌综合征并腓总神经麻痹

手法治愈梨状肌综合征并腓总神经麻痹广西桂林地区医院（５４１００１）覃世才梨状肌综合征并腓总神经麻痹在临床上较少见。１９７７年２月至１９９１年５月我们用手法治愈６例。经近期（４～８个月）及远期（８～１３年）随访各３例，均无复发。报告如下。临床资料本组男...     

血管腔内介入治疗Cockett综合征

目的 探讨血管腔内介入治疗在Cockett综合征中的临床应用价值.方法 1995-2004年对180例Cockett综合征患者进行血管腔内介入治疗,无血栓形成组（A组）100例,91例建立静脉通道,其中3例行单纯球囊扩张术（PTA）,88例行内置支架术（PTA＋stenting）;血栓形成组（B组）80例,70例建立静脉通道,其中55例行单纯PTA,15例行内置支架术.结果 本组无手术死亡,无肺动脉栓塞发生,A组3例,B组3例支架内血栓形成,B组4例血栓复发.随访A组74例（随访率74%）,B组56例（随访率70%）,随访时间为2个月至8年,平均37个月.A组64例中2例支架内血栓形成,8例髂静脉闭塞;B组31例中10例发生血栓综合征,3例支架内血栓形成,5例血栓复发,7例髂静脉闭塞.结论 血管腔内介入治疗Cockett综合征安全、有效,近、中期效果良好.     

上腔静脉阻塞综合征非体外循环下血管置换术的麻醉管理

上腔静脉阻塞综合征多由于右肺上叶癌或右上纵隔肿瘤肿块较大时压迫上腔静脉（SVC）及左右无名静脉所致。使用体外循环或非体外循环方法行肿瘤切除和SVC置换既可切除肿瘤又可解除SVC的阻塞，但是非体外循环下上腔静脉置换术的麻醉具有一定的挑战性。笔者于2000～2005年为9例在非体外循环下阻断SVC行肿瘤切除及SVC移植术的上腔静脉患者成功地进行了麻醉，现报告如下。     

温血心麻痹液心肌保护作用的实验研究

作者对离体大鼠心脏灌注不同心麻痹液，观察停跳缺血缺氧１２０分钟后心率，左室收缩压，心输出量，心肌含水量，钙含量及进行组织病理检查，对３７℃缺血缺氧２０分钟的离体兔心灌注不同心麻痹液，观察心麻痹液灌注期间不同时段心脏动脉液ＰＨ、氧含量差值，自体动脉血再灌注２０分钟心脏左心室收缩压与心率的乘积。右房采用测ＣＰＫ、ＭＤＡ含量，心肌ＡＴＰ、ＣＰ含量，组织病理检查，结果表明：温血心麻痹液在为停跳心肌供氧，保     

Use of Intravenous Hydroxocobalamin for Vasoplegic Syndrome in Simultaneous Liver-Kidney Transplant: A Case Report

Vasoplegic syndrome can occur after reperfusion in liver transplantation. Generally, vasopressor infusions along with volume resuscitation are used to combat this process. There are case reports of the use of hydroxocobalamin to improve vasoplegia in liver transplant and cardiac surgery. In this case report, we describe a patient who received hydroxocobalamin for a simultaneous liver-kidney transplant. Use of this medication facilitated a prompt decrease of very high-dose vasopressor infusions and allowed completion of the kidney transplantation portion of this case. To our knowledge, use in combined liver-kidney transplant has not been described. In light of the dearth of medications to improve vasoplegia outside of vasopressor infusions, the use of hydroxocobalamin as a therapeutic intervention may gain importance.     

Vasoplegic syndrome during Whipple procedure

Vasoplegic syndrome is an unusual cause of refractory hypotension under general anesthesia. It is commonly described in the setting of cardiac surgery, but rarely seen in noncardiac setting. We describe successful management of vasoplegic syndrome during Whipple procedure with vasopressin infusion. A high index of suspicion and prompt treatment with vasopressin can be lifesaving in patients with risk factors for vasoplegic syndrome who present with severe refractory hypotension and who respond poorly to fluid administration and routine vasopressor infusion.     

Vasoplegic syndrome--the role of methylene blue.

Vasoplegic syndrome is a recognized complication following cardiac surgery using cardiopulmonary bypass and is associated with increased morbidity and mortality. In several patients profound post-operative vasodilatation does not respond to conventional vasoconstrictor therapy. Methylene blue has been advocated as an adjunct to conventional vasoconstrictors in such situations. There is limited data pertaining to the use of methylene blue and a number of reports have been anecdotal observations. This article reviews the incidence and problems associated with the vasoplegic syndrome, the mechanism of action of methylene blue, its effects and adverse reactions and the literature supporting its intra-operative and post-operative use. In cases where first-line therapy fails, the use of methylene blue seems to be a potent approach to refractory vasoplegia. The early use of methylene blue may halt the progression of low systemic vascular resistance even in patients responsive to norepinephrine and mitigate the need for prolonged vasoconstrictor use. However, dosing regimens and protocols need to be clearly defined before widespread routine use. Whether methylene blue should be the first line of therapy in patients with vasoplegia is a matter of debate, and there is inadequate evidence to support its use as a first line drug. More scientific evidence is needed to define the role of MB in the treatment of catecholamine refractory vasoplegia.     

Vasoplegic syndrome after off-pump coronary artery bypass surgery.

OBJECTIVE: The vasoplegic syndrome (VS) has been implicated in life-threatening complications after open heart surgery, where the whole-body inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting (OPCAB) has been recently achieving growing enthusiasm mainly due avoiding the side effects of CPB. However herein the occurrence of VS in OPCAB is reported. METHODS: The vasoplegic syndrome usual findings occurring in the early postoperative period include severe hypotension, tachycardia, normal or elevated cardiac output and low systemic vascular resistance. Four patients underwent to OPCAB presented all the signs of VS intraoperatively or within the first 6 postoperative h. RESULTS: The patients needed aggressive vasoactive drug support for hemodynamic stabilization and all of them developed complications. These patients also had tendency to require administration of blood and blood derivatives due to diffuse and oozing type bleeding. Mean intensive care unit stay of surviving patients was 70 h and mean period of postoperative hospitalization was 9 days. Tumor necrosis factor-alpha blood levels in one patient were elevated postoperatively though no signs of infection were observed. One patient died. CONCLUSIONS: Although vasoplegic syndrome can complicate OPCAB surgery, the rationale for avoiding CPB remains valid considering the benefits provided by OPCAB.