新发脑梗死合并冠心病老年患者行颈动脉内膜剥脱术围手术期管理1例  

Perioperative management of carotid endarterectomy in an elderly patient with new cerebral infarction complicated with coronary atherosclerotic heart disease:a case report

作　　者：马进[1] 钟寅波 严敏[1] Ma Jin;Zhong Yinbo;Yan Min(Department of Anesthesia and Surgery,the Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院麻醉手术部,杭州310009

出　　处：《国际麻醉学与复苏杂志》2022年第12期1300-1305,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：颈动脉狭窄是导致缺血性脑卒中的常见病因,颈动脉内膜剥脱术(carotid endarterectomy,CEA)是其重要的治疗方法。颈动脉狭窄的老年患者往往合并高血压、冠心病等多种基础疾病,给手术及麻醉带来了更大的风险和挑战,全面的术前评估和精细的术中管理对患者的围手术期安全至关重要。此例患者术前有明确的脑梗死病史,既往有高血压、冠心病、间质性肺炎病史,术前通过多学科会诊,严格把握手术指征及手术时机,术中通过严格控制血压、重要器官功能监测与保护、维持内环境稳定、抗应激和体温保护等综合措施,使患者安全平稳地度过围手术期,顺利康复出院。Carotid stenosis is a common cause of ischemic stroke,carotid endarterectomy(CEA)is an important treatment.El⁃derly patients with carotid stenosis are often complicated with hypertension,coronary heart disease and other basic diseases,which brings greater risks and challenges to surgery and anesthesia.Comprehensive preoperative evaluation and fine intraoperative manage⁃ment are very important for the perioperative safety of patients.This patient had a clear history of cerebral infarction before operation,and had a history of hypertension,coronary atherosclerotic heart disease and interstitial pneumonia before operation.The operation indi⁃cations and timing were strictly grasped through multidisciplinary consultation before operation.During the operation,comprehensive measures such as strict control of blood pressure,monitoring and protection of important organ functions,maintenance of internal envi⁃ronment stability,anti stress and body temperature protection were taken,the patient passed the perioperative period safely and smooth⁃ly,recovered and discharged smoothly.

关 键 词：颈动脉狭窄 脑梗死 冠状动脉粥样硬化性心脏病 老年人 围手术期 

分 类 号：R541.4[医药卫生—心血管疾病] R743.33[医药卫生—内科学]