心源性脑栓塞ppt课件.ppt

《心源性脑栓塞ppt课件.ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、心源性脑栓塞病历特点中年男性，反复发作渐进性病程；既往高血压史，夹层动脉瘤及主动脉瓣关闭不全换瓣术后3年，口服抗凝药不规范。近2年多次脑梗塞史。发病表现为反复发作的神经功能缺损，渐进性的神经功能缺损。查体主要表现为言语表达障碍，构音含混，右面部麻木及右肢轻偏瘫，及右侧同向偏盲。辅助检查：凝血象（INR）偏低；CT：脑内多发梗塞定位诊断双侧颈内动脉系统，左侧著椎基底动脉系统？定性诊断心源性栓塞主动脉机械瓣膜组织栓子脱落AorticDissectionAnatomy,PhysiologyandPrincipl

2、esofTherapyHistory1555–Vesaliusdiagnosedapulsatingtumornearthevertebraeinapatient’sbackandcalledit“adilatationoftheaorta”18261826–Laennecintroducedthetermdissectinganeurysm1800’s–surgerywasperformedontheentitybyJohnHunter,AstleyCooperandothersevenbeforeth

3、eeraofgeneralanesthesiaEarlyoperationsweredesignedtoproducedistalinternalfenestrationtocausedownstreamdecompressionoftheaorta.History1951LamandAramintroducedhomograftsforrepairofdescendingthoracicaneurysms1953CooleyandDeBakeyusedartificialgraftsforrepair1

4、953Bahnsonintroducedaneurysmorrhaphy1957cardiopulmonarybypassbecameavailableDefinitionTrueaneurysm–localizedenlargementoftheaortacontainedbyallthelayersoftheaorticwallFalseaneurysm–enlargementcontainedbytheaorticadventitiaandperiaorticfibroustissue.Defini

5、tionAorticdissection–SuddencatastrophiceventinwhichatearintheintimaallowsbloodtoescapefromthetruelumenoftheaortarapidlyseparatingtheinnerfromtheouterlayerofthemediaColumnofbloodisdrivenbytheforceoftheleftventricularsystolicpressurewhichstripstheintimafrom

6、theadventitiaDefinitionAcute–lessthan14daysoldChickenortheegg?–Hemorrhageinthemediacausesruptureoftheintimaordissectinghematomainanintimaltear.CausesofAneurysmMedialdegenerationandlocaldilatationAtherosclerosisSyphilis(ascendingonly)Bacterialinfections(my

7、cotic)CongenitalabnormalitiesTraumaAnnuloaorticectasiaCausesofDissectionInherentweaknessoftheaorticwallHypertension–70-90%PregnancyIatrogenicBicuspidaorticvalveandcoarctationClosedchesttraumaPathophysiologyLawofLaplace:Asasphereincreasesinsize,thewalltens

8、ionofthesphereincreasesWeakenedwallDilatationExpansionwithpressure-relatedsymptomsRuptureNaturalHistoryNotwelldocumentedSigns,symptomsandprognosisrelatedtothesizeoftheaneurysmThoracicaneurysmslargerthan6cmaremorepro