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第二十四章 围手术期急性心肌 缺血与心肌梗死 PowerPoint PPT Presentation


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第二十四章 围手术期急性心肌 缺血与心肌梗死. 郧阳医学院麻醉学系 王 贤 裕. 前 言. 术前紧张、术中麻醉和手术创伤、术后疼痛等因素,围手术期急性心肌缺血并不少见,重者可发生急性心肌梗死 (AMI) 。 围手术期急性心肌缺血大多见于原有冠状动脉疾病 (CAD) 的手术病人。 及时有效地诊断和治疗围手术期心肌缺血可明显降低心肌梗死的发生,并改善患者的预后。. 心肌缺血是由于心肌灌注不足或心肌氧供与氧需关系失衡所致,即心肌氧供下降或(和)心肌氧需增加而引起。. 第一节  围手术期心肌缺血的原因. 影响心肌氧供 / 氧需的因素. 一、心肌氧供下降.

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第二十四章 围手术期急性心肌 缺血与心肌梗死

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  • (AMI)

  • (CAD)



/



1

  • (1)

  • (2)

  • STST


2.


3.


  • 6525



1.


2.


3.

  • LVEDP

  • 1

  • 2



  • ECG(TEE)



1.ECG

ECG


  • ECGJ0.06s ST0.1mVJ0.08s ST0.2mVST0.15mV

  • TQTQRS


  • ECG

  • STT



2. TEE

TEE(RWMA)

25RWMAECG50ECG


3.

(PCWP)

ECGTEE




ECG

QAMIECGQSTTRSTT

QAMIQST 0.1 mVaVRSTT


  • AMI

  • (CPK)LDH)(AST)

  • CPK-MBTLDHI

  • AMI


24-3 AMI


  • CPK

    CPK

    CPK-MBCPK-MB/CPK

    CPK-MB46h1824h23

    812hCPK-MB


2.

CPK-MB

IT212h1024h514

CPK-MBAMICPK-MBAMI


3. LDH

LDHAMILDH

LDH1LDH21AMI


1. TEETEERWMAMI

2.

  • (1)[CIL/ (minm2)]2.74.3>2.2CI<2.2CO

  • (2)(PCWP)PCWP


3.

-(rate-pressure productRPP)

RPP12 000RPPPCWP(triple indexTI)RPP150 000

4.


5.

  • CADCAD




  • 70

    AMI

    ECG





1.



patient controlled analgesiaPCA


/


1

  • 70bpm


2.

  • 20


3.

13872

2137



1.


2.

  • AMI

  • AMl



4.

-


5ACEI

ACEI

ACEI


6.

AMI

AMIQQ


7.

AMI24h

AMI24h

AMI


8. AMI

9 -(GIK) AMIGIK

10.



42012068590


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