心胸麻醉进展

心胸麻醉进展

Theadvancementofcardiothoracicanesthesia2012VAT房颤射频消融术术后6m有效率>90%

TEE排除左心耳血栓胸外除颤电极无需肝素化OLV麻醉体会较侧卧易低氧症；阻断肺静脉时低血压。瓣膜病治疗进展Transcathetertransseptaldouble-orificerepair,短、中期明显缓解MVR.

HemodynamicOutcomeofaDoubleMitraClipImplant(A)Bidimensionalechocardiographyat60°toshowtheintercommissuralview.Twoclipsareimplantedinthemiddleofthevalve.(B)Thediastolicflowshowsnoturbulence.(C)Aresidualminimaljetisfoundlaterallytothesecondimplantedclip.MinimallyInvasiveValveSurgery创伤小；相对长的主A阻断时间和CPB时间；相同死亡率和CNS损伤；股A灌注可能使老年病患术后中风风险高.麻醉体会

OLV，体外除颤，放置右侧CVP（左颈内16~18F辅助静脉引流），TEE引导静脉导管置入，CPB中持续CVP测量。示经股静脉插入的静脉引流管，需使其开口位于上腔静脉入口。TranscatheterAorticValveImplantation适用于不能耐受常规瓣膜手术的重度主动脉瓣狭窄病人，经股动、静脉，或经心尖。30d死亡率12~14%，而经心尖为6~10%麻醉挑战，心功差，高龄且合并症多全麻，或局麻结合深度镇静ADVANCESINCORONARYARTERYDISEASECoronaryArterySurgeryinHeartFailureAnassessmentofmyocardialviabilitydidnotcorrelatewithenhancedsurvivalafterCABGsurgeryascomparedwithmedicaltherapy.Inpatientswithtriple-vesselcoronaryarterydisease,CABGsurgeryoffersbetterrelieffromanginathanPCIwithdrugelutingstents.PatientswithsignificantischemicbutviablemyocardiuminthedistributionofacoronaryarterywithsevereproximaldiseaseshouldberevascularizedwhetherbyPCIorCABGsurgery.ADVANCESINHEMATOLOGY

TheOralFactorXaInhibitorsRivaroxaban利伐沙班,Apixaban阿哌沙班拮抗药物尚处于研究阶段，prothrombincomplexThrombinInhibitorsDabigatran

达比加群，快速起效，无需监测，但没有拮抗剂。其导致的严重出血需要recombinantactivatedfactorVII治疗BloodConservationPreoperativeInterventionsforBloodConservationErythropoeitinAntifibrinolyticTherapyFreshFrozenPlasma,RecombinantfactorVIIa,FactorXIII,FactorIXLeukoreduction,plateletplasmapharesis,andbloodsal