心胸麻醉进展.ppt

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1、心胸麻醉进展 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望VAT房颤射频消融术房颤射频消融术术后术后6m有效率有效率90%TEE排除左心耳血栓排除左心耳血栓胸外除颤电极胸外除颤电极无需肝素化无需肝素化OLV麻醉体会麻醉体会较侧卧易低氧症；阻断较侧卧易低氧症；阻断肺静脉时低血压。肺静脉时低血压。瓣膜病治疗进展瓣膜病治疗进展Transcatheter transseptal double-orifice repair,短、中期明显缓解MVR.Hemodynamic

2、Outcome of a Double MitraClip Implant(A)Bidimensional echocardiography at 60 to show the intercommissural view.Two clips are implanted in the middle of the valve.(B)The diastolic flow shows no turbulence.(C)A residual minimal jet is found laterally to the second implanted clip.Minimally Invasive Val

3、ve Surgery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.麻醉体会麻醉体会 OLV，体外除颤，放置右侧CVP（左颈内1618F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。Transcatheter Aortic Valve Implantation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1214%，而经心尖为610%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ADVANCES IN HEMATOL

4、OGYThe Oral Factor Xa Inhibitors Rivaroxaban 利伐沙班,Apixaban 阿哌沙班 拮抗药物尚处于研究阶段，prothrombin complexThrombin InhibitorsDabigatran 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recombinant activated factor VII治疗Blood ConservationPreoperative Interventions for Blood Conservation1.Erythropoeitin2.Antifibrinolytic Therapy3.Fresh Frozen Plasma,Recombinant factor VIIa,Factor XIII,Factor IX4.Leukoreduction,platelet plasmapharesis,and blood salvage are all components of a multimodal approach to optimize perioperative transfusion practice.