非心脏手术患者围手术期的Ebstejn异常

Ljubiša Mirić, Tijana Smiljković, V. Perić, S. Mirić, Tjasa Ivosevic
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摘要

Ebstein畸形是一种先天性心脏缺陷,其特征是三尖瓣的形态和功能异常,同时三尖瓣的口向右心室的顶点移动。病例报告:一名39岁的患者在急腹症的影像下入院,需要紧急手术治疗。进行常规术前准备、化验室处理、内科检查及局部麻醉师检查。他有呼吸道感染期间偶尔出现呼吸问题的病史,吸烟。除原发问题外,临床情况良好。手术治疗顺利通过,术后第4天患者主诉窒息、憋气、胸痛,转化为重症监护监护(spo2 87% f约110/min TA 90/60),血气分析及化验室治疗(纤维蛋白原、D二聚体),因疑似肺血栓栓塞求诊心脏科医师,超声见右心房扩张。讨论:先天性心脏缺陷患者的非心脏手术是高危手术,围手术期流动性和死亡率增加。根据伴随的病理解剖和病理生理变化来确定先天性心脏缺陷,必须制定详细的计划-对每个患者分别进行麻醉管理。血流动力学和呼吸稳定,避免缺氧和矛盾性心律失常是Ebstein异常患者的基本假设。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ebstejn's anomaly in patients perioperative period during a non-cardiac surgery operation
Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.
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