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一名使用左心室辅助装置(LVAD)的患者进行的连续性白内障手术。

Sequential cataract surgeries in a patient with a left ventricular assist device (LVAD).

作者信息

Yang Alina, Liu Ji

机构信息

Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA.

出版信息

BMJ Case Rep. 2018 Mar 16;2018:bcr-2018-224238. doi: 10.1136/bcr-2018-224238.

Abstract

The population of patients on left ventricular assist devices (LVADs) has increased significantly since the 1990s, and with it, need for non-cardiac elective surgeries. Presence of an LVAD or heart failure, however, can cause physicians to perceive these patients to be at prohibitively high risk for elective surgery. Nevertheless, as one of the most common causes of poor vision in the elderly, cataracts can significantly limit improvements in quality of life that a patient may have otherwise gained from LVAD support. We describe the case of a 62-year-old man with an LVAD who underwent two uncomplicated sequential cataract surgeries following extensive cardiology evaluations and intraoperative monitoring by anaesthesia without intravenous sedation. The patient reported significant improvement in visual acuity and quality of life. Our case demonstrates the potential benefits of conducting cataract surgery relatively early in the disease course in patients with LVAD devices.

摘要

自20世纪90年代以来,使用左心室辅助装置(LVAD)的患者数量显著增加,随之而来的是对非心脏择期手术的需求。然而,LVAD的存在或心力衰竭会使医生认为这些患者进行择期手术的风险高得令人望而却步。尽管如此,白内障作为老年人视力下降的最常见原因之一,会显著限制患者原本可能从LVAD支持中获得的生活质量改善。我们描述了一名62岁使用LVAD的男性患者的病例,该患者在经过广泛的心脏病学评估以及麻醉科在无静脉镇静情况下进行术中监测后,顺利接受了两次连续的白内障手术,且未出现并发症。患者报告视力和生活质量有显著改善。我们的病例证明了在LVAD装置患者疾病进程相对早期进行白内障手术的潜在益处。

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本文引用的文献

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A Decade of Experience With Continuous-Flow Left Ventricular Assist Devices.连续流左心室辅助装置十年经验
Semin Thorac Cardiovasc Surg. 2016;28(2):363-375. doi: 10.1053/j.semtcvs.2016.05.013. Epub 2016 Jun 11.
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Ventricular assist devices and non-cardiac surgery.心室辅助装置与非心脏手术。
BMC Anesthesiol. 2015 Dec 19;15:185. doi: 10.1186/s12871-015-0157-y.
5
Cataract surgery in patients with left ventricular assist device support.左心室辅助装置支持下的白内障手术。
J Cataract Refract Surg. 2014 Apr;40(4):675-8. doi: 10.1016/j.jcrs.2014.01.024. Epub 2014 Feb 22.
9
Non-cardiac surgery in patients on long-term left ventricular assist device support.长期左心室辅助装置支持患者的非心脏手术。
J Heart Lung Transplant. 2012 Jul;31(7):757-63. doi: 10.1016/j.healun.2012.02.023. Epub 2012 Mar 14.
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Case 6-2010: Noncardiac surgery in patients with a left ventricular assist device.
J Cardiothorac Vasc Anesth. 2010 Dec;24(6):1002-9. doi: 10.1053/j.jvca.2010.09.005.

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