心脏病人非心脏手术的麻醉精品课件

1、2021/4/2612021/4/262冠心病病人非心脏手术的麻醉1. 术前评估2. 术前准备3. 术中处理4. 术后处理2021/4/263共计死亡1871788人，心脏病死亡占总数的38.7%2021/4/2642021/4/265据调查，从1964年至1999年，80岁以上老人从2.92万增至28.49万，35年内上升近10倍2021/4/266医疗费用增长大大超过GNP 的增长！2021/4/2672021/4/2682021/4/2692021/4/26102021/4/26122021/4/26132021/4/2614病 史体格检查特殊的心血管检查2021/4/26152021/

2、4/26162021/4/26172021/4/26182021/4/26192021/4/26202021/4/26212021/4/26222021/4/26232021/4/26242021/4/26252021/4/26262021/4/26272021/4/26282021/4/26292021/4/2630心脏特殊检查无创检查冠状动脉造影常规心电图运动心电图动态心电图超声心动图放射性核素扫描2021/4/26312021/4/26322021/4/26332021/4/26342021/4/26352021/4/26362021/4/26372021/4/26382021/4/26

3、392021/4/26402021/4/2641Graybum PA, et al. Ann Intern Med, 2003, 138: 506 - 511Positive likelihood ratio 10, Negative likelihood ratio 10, Negative likelihood ratio 0.2多巴酚丁胺应激超声心动图的价值2021/4/26492021/4/26502021/4/26512021/4/26522021/4/26532021/4/26542021/4/26552021/4/26562021/4/26572021/4/26582021/4/

4、26592021/4/26602021/4/26612021/4/2662术前心脏评估的步骤1. 外科手术的紧急程度2. 在5年内是否做过CABG3. 近期内是否做过心脏评估4. 临床有何种程度危险因素5. 病人的体能状况如何6. 计划进行外科手术的危险程度2021/4/2663择期外科手术 急诊手术 CABG 4METs）低危手术中危手术高危手术手术室考虑 冠状动脉造影 取消或推迟手术 内科治疗体能差（ 4METs）手术室体能差（4METs）中、低危手术高危手术无创检查冠脉造影2021/4/26642021/4/2665 非致命性心肌梗死、充血性心力衰竭和室性心动过速2021/4/26662

5、021/4/26672021/4/26682021/4/26692021/4/26702021/4/26712021/4/26722021/4/26732021/4/26742021/4/26752021/4/26762021/4/26772021/4/26782021/4/26792021/4/26802021/4/26812021/4/26822021/4/26832021/4/26842021/4/26852021/4/26862021/4/26872021/4/2688心肌缺血心肌氧供减少心肌氧耗增加冠脉血流减少血液携氧量减少心动过速舒张压过低前负荷增加低碳酸血症冠状动脉痉挛贫血低碳酸

6、血症2, 3DPG减少心动过速心肌收缩力增强心室壁张力增加心脏后负荷增加心脏前负荷增加2021/4/26892021/4/26902021/4/26912021/4/26922021/4/26932021/4/26942021/4/2695硬膜外阻滞对冠心病病人是否有利，受多种因素的影响。其中硬膜外阻滞的平面起重要作用。一般认为硬膜外阻滞对心脏的保护作用应是阻滞平面达到胸1水平2021/4/26962021/4/2697The skill & experience of the anesthesiologist, including the ability to monitor hem

7、odynamics & respond quickly, are far more important than the specific agent used.2021/4/26982021/4/26992021/4/26100Landesberg G. The pathophysiology of perioperative myocardial infarction: Facts and perspectives. JCVA, 2003, 17 (1): 90 100.2021/4/261012021/4/261022021/4/261032021/4/261042021/4/261052021/4/261062021/4/26107安装起搏器病人的评估和处理程序 1. 了解原发疾病以及病人对起搏器的依赖程度 2. 了解起搏器：类型和功能等 3. 了解病人目前的症状和心功能状况 4. 了解外科情况，手术部位与起搏器的关系等 5. 调整起搏器：频率和工作方式等。关闭特殊功能 6. 术中监测心律和心率等 7. 术后心内科专科会诊2021/4/261082021/4/261092021/4/261102021/4/261112021/4/261122021/4/261132