针对急性肺栓塞的导管性血栓切除术患者的麻醉管理:叙述性综述
Julian Rössler1, Jacek B Cywinski2, Maged Argalious3
1Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
Journal of clinical anesthesia
|October 9, 2023
概括
麻醉科医生可以安全地管理接受肺栓塞 (PE) 导管血栓切除术的患者. 本综述指导了接受这些救命手术的重症患者的麻醉评估和管理.
科学领域:
- 心脏病学 心脏病学
- 麻醉学 麻醉学
- 肺部医学 肺部医学
背景情况:
- 肺栓塞 (PE) 是心血管死亡的主要原因.
- 皮肤导管式血栓切除术越来越多地用于高风险PE,特别是当血栓溶解禁用时.
- 这些干预程序需要麻醉师的存在,因为危急病患者的心肺呼吸系统损害的风险.
研究的目的:
- 为麻醉科医生提供指导,评估和管理因急性肺栓塞而接受导管性血栓切除术的患者.
- 审查现有的血栓切除术技术,风险分层和患者评估.
- 讨论麻醉策略,包括监控麻醉护理和全身麻醉,以及血液动力学扰乱和右心室功能障碍的管理.
主要方法:
- 关于肺栓塞的导管式血栓切除术现有文献的叙述性综述.
- 讨论风险分层工具和程序前的患者评估.
- 分析麻醉策略,监测和管理并发症,包括右心室衰竭.
主要成果:
- 导管血栓切除术是高风险PE患者的可行选择,通常有对血栓溶解的禁忌.
- 麻醉管理需要对重症患者进行仔细评估,重点关注血液动力学稳定性和右心室功能.
- 策略范围从基本监测到先进的疗法,如肌肉扩展剂和机械循环支持.
结论:
- 麻醉师在成功和安全地执行急性肺栓塞的导管式血栓切除术中发挥着至关重要的作用.
- 需要量身定制的麻醉方法,以减轻脆弱患者与这些程序相关的风险.
- 血液动力学不稳定性和右心室功能障碍的有效管理对于最佳的患者结果至关重要.
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