在接受冠状动脉旁路移植的患者中进行冠状动脉干预:叙述性审查
Andrea Xodo1, Alessandro Gregio1, Fabio Pilon1
1Vascular and Endovascular Surgery Division, "San Bortolo" Hospital, AULSS8 Berica, 36100 Vicenza, Italy.
Journal of clinical medicine
|June 19, 2024
概括
同时管理动脉狭窄和冠状动脉疾病需要个性化策略. 本综述探讨了手术,分阶段和混合方法,以减少心脏手术期间的中风风险.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
背景情况:
- 同时的动脉狭窄 (CS) 和冠状动脉疾病 (CAD) 经常在患有心血管风险因素的患者中并存.
- 对并发CS和CAD的最佳管理策略仍在调查中.
- 动脉疾病和围手术中风之间的因果关系,以及预防性动脉再血管化的好处,是正在进行研究的领域.
研究的目的:
- 审查和总结当前的方法来管理冠状动脉绕道移植 (CABG) 手术的患者的关动脉疾病.
- 讨论CAD患者中CS手术,分期和混合干预的最新进展.
- 为这些复杂的患者强调个性化治疗策略的重要性.
主要方法:
- 关于联合CS和CAD管理的当前文献和临床实践的审查.
- 对同步 (CEA之前的CABG),分阶段 (CEA/CABG或CABG/CEA) 和混合 (CAS与CABG) 方法的分析.
- 评估在接受CABG的患者中降低术后中风风险的策略.
主要成果:
- 在选择的患者中,可以考虑同步动脉内关节切除术 (CEA) 和CABG,以减轻外科期间中风风险.
- 阶段性手术 (CEA接下来是CABG,反之亦然) 和混合方法 (动脉支架 (CAS) 与CABG) 提供了替代的管理选择.
- 量身定制的,个性化的方法至关重要,特别是对于无症状患者来说,以确定最佳的手术策略.
结论:
- 对CS和CAD患者的管理需要个性化的方法,考虑各种手术和干预选择.
- 同步,分阶段或混合程序之间的选择应基于个体患者的因素和风险评估.
- 需要进一步的研究来完善这种高风险患者群体的最佳管理方案.
相关概念视频
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:26Angina IV: Management
IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
01:27Peripheral Artery Disease III: Interprofessional Care
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...