心血管手术后脑血管事件:诊断、处理和预防策略。

Maria Sabrina Ferrante, Calogera Pisano, Jérôme Van Rothem, Giovanni Ruvolo, Issam Abouliatim
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引用次数: 0

摘要

心脏手术后脑血管事件是最严重的并发症之一,与患者死亡风险增加有关。这个问题可能发生在心脏直视手术中形成气体栓塞之后。目的:探讨可能导致心血管手术后栓塞事件的所有机制,如何处理它们以及如何可能地预防它们。材料和方法:检索PubMed数据库。我们回顾了临床文献,并检查了各个方面,以确定可能导致栓塞形成的根本原因。结果:在回顾的研究中,发现主动脉操作、心脏手术后脱氧不充分、体外循环血液成分接触是导致主动脉脱氧的主要原因。据报道,气体栓塞可导致有害的损害,如对脑血管内皮的损害、血脑屏障的破坏、补体活化、白细胞聚集、血小板粘附增加和微血管系统的纤维蛋白沉积。结论:卒中是心血管手术后最重要的并发症之一,严重影响手术死亡率和患者生存。随着时间的推移,人们努力了解与该并发症相关的所有病理生理机制,以减少其发生率。其中一个目标应该是改进手术技术和灌注方式,尽量减少气泡的形成或促进体外循环过程中气泡的消除。
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Cerebrovascular events after cardiovascular surgery: diagnosis, management and prevention strategies.

Introduction: Cerebrovascular events after cardiac surgery are among the most serious complications, related to a greater risk of patient mortality. This problem can occur following the formation of gas emboli during open heart surgery.

Aim: To address all the mechanisms that can lead to embolic events after cardiovascular surgery, how to manage them and how to possibly prevent them.

Material and methods: A search of the PubMed database was conducted. We reviewed the clinical literature and examined all aspects to identify the root causes that can lead to the formation of emboli.

Results: Among the studies reviewed, it was found that the main causes include manipulation of the aorta, inadequate deaeration after cardiac surgery, and blood-component contact of extracorporeal circulation. It has been reported that gas emboli can lead to deleterious damage such as damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adhesion, and fibrin deposition in the microvascular system.

Conclusions: Stroke after cardiovascular surgery is one of the most important complications, with a great impact on operative mortality and patient survival. Efforts have been made over time to understand all the pathophysiological mechanisms related to this complication, with the aim of reducing its incidence. One of the goals should be to improve both the surgical technique and the perfusion modality and minimize the formation of air bubbles or to facilitate their elimination during the cardiopulmonary bypass procedure.

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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Polish Journal of Thoracic and Cardiovascular Surgery is a quarterly aimed at cardiologists, cardiosurgeons and thoracic surgeons. Includes the original works (experimental, research and development), illustrative and casuistical works about cardiology and cardiosurgery.
期刊最新文献
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