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 Posted: Fri 7:38, 11 Mar 2011 Post subject: asics tiger shoes Endovascular treatment of intrac |
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,[link widoczny dla zalogowanych]
Endovascular treatment of intracranial wide-necked aneurysms with intraoperative care
,[link widoczny dla zalogowanych], And 1 transient ischemic attack (TIA). l2 patients underwent cerebral digital subtraction angiography (DSA) and three-dimensional imaging, nerve involvement by experienced physicians and patients with tumors the size of the aneurysm neck were measured. Ophthalmic artery aneurysm in 3 cases,[link widoczny dla zalogowanych], 4 cases of posterior communicating artery aneurysm,[link widoczny dla zalogowanych], 2 cases of vertebral artery aneurysm,[link widoczny dla zalogowanych], 2 cases of the lower basilar artery aneurysm, l cases of anterior communicating artery aneurysm. All aneurysm neck> 4ixinl or aneurysm neck body ratio <1 / 2. Maximum aneurysm was 12mm × 8mm × 5mm, the smallest aneurysm is 3mmx4mm × 3mlTi. Treatment: All aneurysms were first with the conventional electrolytic micro-coil embolization, due to unclear or aneurysm neck coil and switch broke into the parent artery stent adjuvant therapy. Patients after general anesthesia, using Seldinger technique, the line right femoral artery puncture, systemic heparin anticoagulation. Accurate measurement of aneurysm neck surgery in the length of parent artery proximal and distal width, accurate and select the appropriate support, home cervical human tumors, imaging to determine stent position, and then Guglielmi detachable coil (GDC) packing artery tumor tumor cavity to achieve compact packing aneurysm cavity. 2 Preoperative Nursing Care 2.1.1 with 2.1 psychological care: ① to talk with patients to eliminate fear. Explain to the patient and meticulous preoperative preparation, surgical procedures, precautions, to obtain the cooperation of patients. 13 preoperative aspirin 0.3ms / d, continuous 3d. Preoperative oral ticlopidine 250mg / d or clopidogrel 75mg / d, continuous 3d. ② preoperative blood and urine routine examination will be four tests and coagulation, with particular attention fibrinogen, a clotting when asked, liver and kidney function and so on. Intravenous iodine allergy test, asking whether patients with drug allergy history. ③ required preoperative 4-6h of fasting, water deprivation, bilateral perineal area of skin preparation, preoperative indwelling catheter and so on. 30min before surgery Author: 100053 Beijing, Xuanwu Hospital, Capital Medical University, interventional radiology treatment centers l0mg intramuscular injection of diazepam or phenobarbital sodium 0.2g. ④ to patients configuration electrocardiogram, blood oxygen, blood pressure, anesthesia machines and other monitoring equipment. ⑤ patients given general anesthesia. Patients were given pre-trocar to ensure smooth operation in the vein. ⑥ close observation of vital signs and patient awareness of the state to prepare for the rescue of goods and medicines. Ensure timely and accurate intraoperative medication, particularly the application of heparin to avoid inadequate or excessive anticoagulation caused by thrombosis or bleeding. Pay attention to skin care, the site of application of compression decompression paste. 2.1.2 Material preparation: ① 5F cerebral angiography tube, 6F guide sheath, 0.89mm loach guide wire, 6FEnvoy guiding catheter, Y-shaped valve, hemostatic valve, Neuroform stents, coronary stent, the pressure pump. ② microcatheter: Co-dis-Prower. 10, EXCEl a 14, Tracker-10. ③ micro-guide wire: equipped with 0.25mm, 0.36mill micro-guide wire. ④ Electrolysis and Electro relief, electric free Coil (GDC). 2.2 2.2.1 Intraoperative care with close coordination with the surgeon: familiar with each procedure and accurate delivery of catheter materials and articles, along with strict compliance with aseptic technique. 2.2.2 observe the patient's vital signs: When the patient is under general anesthesia state, not through the patient's awareness of changes, headache, vomiting, etc. to determine whether an aneurysm rupture or cerebral vasospasm. Therefore, we must closely observe the changes in blood pressure. Closely the image on the screen, unusual, a timely reminder of surgery for disposal. Because the aneurysm neck in the parent artery at the internal one stent, aneurysm neck stand to bear the pressure, it appears very easy to rupture or stent migration phenomenon. Blood pressure control should be the basis of blood pressure in patients below 20% level, using micro-pump surgery, continuous infusion of sodium nitroprusside. Preoperative, intraoperative and postoperative intravenous infusion of nimodipine routine, can prevent cerebral vasospasm, but also the control patients due to anesthesia, awakening or tracheal extubation caused by high blood pressure. 2.2.3 Prevention of intravascular thrombosis: the first dosage of heparin in patients with weight in kilograms of 2/3mg, asked the first time, every lh intravenous heparin dose given 1 / 2, after an interval of 1h to give the 2nd dose of 1 / 2 to maintain. Intraoperative heparin to accurately record the time each application, dose. Heparin half-life master in order to prepare timely surgery, accurately calculate the amount of heparin. 3 Results l2 cases of wide-necked aneurysms, underwent endovascular treatment. Review after angiography, aneurysm undeveloped. Postoperative follow-up, the patient no case be complications such as bleeding and thrombosis, were discharged.
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