主动脉夹层.ppt.ppt

Guangdong Cardiovascular InstituteThoracicaortaAbdominalaortaAortic dissectionAortaBlood in wall of arteryBlood in arteryStanford A型相当于型相当于Debakey 型和型和型型,Stanford B 型相型相当于当于Debakey 型型型 型 型DeBakey In the absence of contraindications,intravenous beta blockade should be initiated and titrated to a target heart rate of 60 beats per minute or less.In patients with clear contraindications to beta blockade,nondihydropyridine calcium channelblocking agents should be used as an alternative for rate control.nIf systolic blood pressures remain greater than 120mm Hg after adequate heart rate control has been obtained,then angiotensin-converting enzyme inhibitors and/or other vasodilators should be administered intravenously to further reduce blood pressure that maintains adequate end-organ perfusion.nBeta blockers should be used cautiously in the setting of acute aortic regurgitation because they will block the compensatory tachycardia.GuidelinenVasodilator therapy should not be initiated prior to rate control so as to avoid associated reflex tachycardia that may increase aortic wall stress,leading to propagation or expansion of a thoracic aortic dissection.分支重建+管型移植物隔绝分支动脉处理探索分支动脉处理探索弓上分支弓上分支第二个破口第二个破口分支动脉处理探索分支动脉处理探索腹腔内脏动脉腹腔内脏动脉移植物开窗技术