冠心病合并颈动脉狭窄的围术期处理

背景 冠心病(coronary artery bypass grafting,CABG)合并颈动脉狭窄者临床上并不少见.如何正确处理CABG患者并存颈动脉狭窄的问题应引起重视.目的 为了探索CABG患者并存颈动脉狭窄的最佳处理方法,此文将CABG患者并存颈动脉狭窄的外科治疗及麻醉处理进行了分析汇总.内窖对于合并颈动脉狭窄的CABG患者,最佳治疗策略尚未达成共识.既往外科治疗多采用分期或同期颈动脉内膜剥脱术(carotid endarterectomy,CEA),但近年来随着经皮介入治疗技术的发展,大多数可以采用分期或同期经皮颈动脉支架置人术(carotid artery stenting,CAS).CABG合并颈动脉狭窄患者围术期麻醉处理的关键是维持血流动力学平稳,保证大脑的有效灌注压,避免脑缺血和栓塞.趋向 同日CAS-CABG"杂交"手术已显示出可行性,并有待进一步研究.

Perioperative management in patients with concomitant carotid and coronary artery disease

Background Patients undergoing coronary artery bypass grafting (CABG) concomitant with carotid stenosis are very common in clinic. How to optimally manage such patients is always worthy of attention. Purpose In order to figure out optimal methods to manage patients with carotid stenosis scheduled for CABG, this article has reviewed surgical treatments and perioperative anesthetic managements of patients undergoing CABG concomitant with carotid stenosis. Content Optimal management of patients with combined coronary and carotid artery disease remains controversial. Staged or combined carotid endarterectomy (CEA) and CABG were generally adopted in the past. Recently, with the development of percutaneous intervention techniques, many patients can undergo staged or combined carotid artery stenting (CAS) and CABG. The key point to deal with such patients is maintaining hemodynamic stabilization, to ensure sufficient perfusion to brain and avoid cerebral ischemia or embolism. Trend Same-day hybrid revascularization by carotid stenting and CABG is feasible, but still needs further research.