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椎动脉多层螺旋CT血管造影在后循环缺血诊断中的临床应用价值
目的：探讨椎动脉多层螺旋CT血管造影（CTA）在后循环缺血（PCI）诊断中的临床应用价值。方法对我院确诊收治的63例PCI患者行椎动脉CTA检查，对椎动脉的起始、走行、血管腔狭窄及周围压迫情况进行分析。结果63例PCI患者CTA检查检出椎动脉异常者59例（93.7%），其中血管纤细42支，血管走行及开口异常35支，动脉狭窄110段，椎动脉闭塞9段，椎体骨质增生压迫血管104段。结论椎动脉CTA检查在PCI诊断中具有重要价值，能够为临床治疗提供重要依据。
Abstract：
Objective To investigate the clinical application value of multi-slice spiral CT angiography (CTA) in the diagnosis of posterior circulation ischemia (PCI). Methods The vertebral artery CTA examination was performed in 63 cases of patients with PCI admitted to our hospital, and the initial, walking, and vascular lumen stenosis of the vertebral artery were analyzed. Results 63 cases of PCI patients CTA examination in detection of vertebral artery abnormal 59 cases (93.7%), in which vascular slender 42 support, vascular and opening abnormality was found in 35 branches, 110 segments of artery stenosis, 9 segments of vertebral artery occlusion, vertebral bone hyperplasia of vascular compression 104 segments. Conclusion Vertebral artery CTA examination has important value in the diagnosis of PCI, and can provide an important basis for clinical treatment.
XIU Zhenzhi
作者单位：
山东省海阳市中医医院放射科,山东海阳,265100
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Stanford A 型主动脉夹层腔内隔绝术的麻醉及围术期管理
目的：分析 Stanford A 型主动脉夹层（AD）腔内隔绝术的麻醉及围术期管理。方法选取上海市第一人民医院2013年5月--2015年5月收治的 Stanford A 型 AD 患者16例，均在全身麻醉下行腔内隔绝术，其中9例先行颈部动脉旁路移植术，7例先行左锁骨下动脉烟囱支架术后再行主动脉腔内隔绝术，术中根据手术需要行控制性升压及降压，分析麻醉及围术期管理要点。结果16例患者均成功完成 AD 腔内隔绝术，手术时间为（128±25）min，术中出血量为100~250 ml。术中患者生命体征平稳，术毕送返重症监护室（ICU）并给予监护治疗，麻醉苏醒后拔除气管导管。手术过程中，5例患者发生房性期前收缩，7例患者发生室性期前收缩。患者术后均未发生截瘫、心肌梗死、肾衰竭、肝功能衰竭、肺部感染、术后出血等传统开胸手术常见并发症，亦未发生恶性心律失常，随访期间心功能和生活质量均明显改善。结论杂交手术和烟囱支架术拓展了 Stanford A 型 AD 腔内隔绝术的治疗适应证，麻醉医生应了解此类手术的操作要点及新进展，以便更合理地实施麻醉及围术期管理，保障患者安全、顺利完成手术。
Abstract：
Objective To analyze the anesthesia and perioperative management of endovascular graft exclusion for Stanford A type aortic dissection. Methods A total of 16 patients with Stanford A type aortic dissection were selected in the First People′s Hospital of Shanghai from May 2013 to May 2015,and all of them received endovascular graft exclusion,thereinto 7 cases received bypass graft of cervical arteries,9 cases received chimney stent implantation of left subclavian artery. Controlled blood pressure elevation or reduction scheme was selectively used during the operation,key points of anesthesia and perioperative management were analyzed. Results All of the 16 patients successfully completed the endovascular graft exclusion for Stanford A type aortic dissection,the mean operation time was( 128 ± 25 ) min,the intraoperatve blood loss was from 100 to 250 ml. During the operation,vital signs of all the patients were stable,and they were transferred to ICU after operation, endotracheal tubes were removed after revival of anesthesia. During the operation,5 cases occurred atrial premature contraction, 7 cases occurred ventricular premature contraction,but no one of the 16 patients occurred malignant arrhythmia after operation, or common postoperative complications of traditional thoracotomy,such as paraplegia,myocardial infarction,renal failure, hepatic failure,pulmonary infection,postduring the follow - up,cardiac function and quality of life of the 16 patients significantly improved. Conclusion Hybrid operation and chimney stent implantation expand the therapeutic indications of endovascular graft exclusion for Stanford A type aortic dissection,anesthesiologists should know the operating points and new progress to reasonably carry out the anesthesia and perioperative management,in order to guarantee the safety and success of surgery.
ZHANG Ying
WANG Zhao-min
ZHOU Ya-chun
CHEN Lian-hua
作者单位：
201600,上海市第一人民医院麻醉科
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万方数据知识服务平台--国家科技支撑计划资助项目（编号：2006BAH03B01）(C)北京万方数据股份有限公司
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