cea手術(shù)室篇(完整版)
【正文】 。 General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial Method: a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. general (n=1753) or local (n=1773) anaesthesia。 術(shù)后麻醉與 TCCD定控制范圍 麻醉機 第十四頁，共六十一頁。 顯微操作前器械 第二十頁，共六十一頁。 ? 肝素： Dose of 5000 units of heparin or 30 u/kg body weight of intravenous heparin。 27: 178–185 第三十頁，共六十一頁。 it is merely identifi ed and left untouched. 觸及 CCA，別離方向：向頭端，由 CCA, ICA, ECA, superior thyroid arteries； 向上： Posterior belly of the digastric muscle〔二腹肌〕 。 阻斷順序： The first clip is applied to the ICA, then one each to the ECA and the superior thyroid artery and finally to the CCA.〔試阻斷〕 Clamps were applied sequentially to the superior thyroid artery, the mon carotid artery, internal carotid artery, and the external carotid artery.〔持續(xù)阻斷〕 返血：分別提起 ECA， ICA阻斷帶；或源于咽升 A，使用較大的阻斷夾完全阻斷 ECA； 第三十七頁，共六十一頁。 遠端 : the arteriotomy on the anterolateral aspect of the internal carotid is taken beyond the severe disease, this being usually within 1–2 centimeters of its origin。 Proximally, obtaining a satisfactory end point may be more difficult. Distally, it is advisable to follow the atheroma until it reaches its thin end point。 IV. More knots are used – usually 7 – and the ends of the stitches are cut longer, some 5–6 mm from the knots. 第四十八頁，共六十一頁。 局部出血的觀察 ? Hemorrhage: dressing, neck swelling, with or without tracheal pression, and blood collected in the drainage bottle ? Continued hemorrhage of greater than 100 ml/h and/or tracheal pression may require reexploration, evacuation of the hematoma and securing hemostasis. 第五十二頁，共六十一頁。 您的聆聽 第六十頁，共六十一頁。 the CCA, C window aneurysm clip at the ICA, P plaque, T superior thyroid artery。 HOW TO AVOID COMPLICATIONS ? PATIENT SELECTION ? ANAESTHESIA (gentle and smooth anaesthesia) ? MONITORING (諸多方面： BP，術(shù)中轉(zhuǎn)流的監(jiān)測，血管縫合后的即刻監(jiān)測，術(shù)后切口的觀察等 ) ? DISSECTION AND ENDARTERECTOMY ? CROSS CLAMPING 〔 Proper sequence of clip application and removal decreases the risk of perioperative embolisation.〕 ? HAEMOSTASIS 〔 meticulous haemostasis〕
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