Rössel T, Paul R, Richter T, Ludwig S, Hofmockel T, Heller A R, Koch T
Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
Klinik für Viszeral-, Thorax- und Gefäßchirurgie, TU Dresden, Dresden, Deutschland.
Anaesthesist. 2016 Dec;65(12):891-910. doi: 10.1007/s00101-016-0241-9.
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
心血管疾病是德国发病和死亡的主要原因之一。对于这些患者，因其高危特征，需要采用跨学科和多模式的治疗方法。过去，血管内介入治疗和血管外科手术已成为该治疗策略的重要组成部分；然而，病理性血管改变的不同解剖部位使得有必要使用广泛的手术选择和方法；因此，麻醉管理的要求各不相同，需要采取差异化的方法。血管内手术可以在全身麻醉或区域麻醉（RA）下对患者进行；然而，在目前可得的文献中，没有证据表明区域麻醉在发病率和死亡率方面优于全身麻醉，尽管对于某些血管内介入治疗，可以发现肺部并发症有所减少。鉴于当前的研究情况以及抗凝治疗的常规使用，在考虑风险效益比并参照最新麻醉指南时，应谨慎考虑硬膜外和脊髓区域麻醉手术。以下文章以一些选定的血管内介入治疗为例，阐明麻醉管理的具体特点。
