心脏病者施行非心脏手术问题

• 作 者: Weitz HH Goldman L 张旭明
• 出 处: 国外医学(内科学分册)
• 发表日期: 1988年06期
• 关键词: 非心脏手术 心脏病者 血流动力学 全身麻醉药 应激反应 冠心病者 心肌耗氧量 充血性心力衰竭 儿茶酚胺类 循环功能障碍

心脏病患者施行非心脏手术时,其代偿机制不足以维持血流动力学的稳定性,加重了原有的循环功能障碍。因此,应设法保护重要器官,消除自律神经与内分泌系统的不良反应,以维持血流动力学的稳定性。对手术的各种正常应激反应,如血中儿茶酚胺类增加、心搏量提高、体液潴留及保持重要器官的灌注,均使心肌耗氧量增加。冠心病者则可由此招致心肌缺血,甚至充血性心力衰竭(CHF),发生心律失常。麻醉的考虑全身麻醉药吸入与静脉注入合用,对心血

Cardiac patients undergoing non-cardiac surgery, the compensatory mechanism is not enough to maintain hemodynamic stability, aggravating the original circulatory dysfunction. Therefore, we should try to protect the vital organs and eliminate the adverse reactions of the autonomic nervous system and the endocrine system in order to maintain the hemodynamic stability. A variety of normal stress response to surgery, such as increased blood catecholamines, increased stroke volume, fluid retention and maintenance of vital organ perfusion, are increased myocardial oxygen consumption. Coronary heart disease can lead to myocardial ischemia, and even congestive heart failure (CHF), arrhythmia. Consideration of anesthesia General anesthesia inhalation and intravenous injection, on the effort