Chatterjee Subhasis, Preventza Ourania, Orozco-Sevilla Vicente, Coselli Joseph S
Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA -
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA -
J Cardiovasc Surg (Torino). 2021 Jun;62(3):220-229. doi: 10.23736/S0021-9509.20.11712-9. Epub 2020 Dec 14.
Thoracoabdominal aortic aneurysm repair is technically demanding for the surgeon and physiologically demanding on the patient. As such, it requires diligent multidisciplinary perioperative care to maximize the likelihood of a successful outcome. In this article, we discuss key principles for managing patients after open thoracoabdominal aortic aneurysm repair, which we have learned over the course of performing more than 3500 of such procedures. These principles address patient handoff between the operating room and Intensive Care Unit, resuscitation, prevention and management of spinal cord deficits, and important neurological, respiratory, cardiovascular, renal, gastrointestinal, and hematological considerations. Understanding the expected postoperative course allows for earlier recognition of deviations from that course and increases the likelihood of successful rescue of patients from adverse outcomes. Achieving positive outcomes after thoracoabdominal aortic aneurysm repair requires attention to detail across the perioperative, intraoperative, and postoperative phases of care.
胸腹主动脉瘤修复术对外科医生来说技术要求很高，对患者来说生理要求也很高。因此，它需要精心的多学科围手术期护理，以最大限度地提高成功治疗的可能性。在本文中，我们讨论了开放性胸腹主动脉瘤修复术后患者管理的关键原则，这些原则是我们在进行了3500多例此类手术的过程中总结出来的。这些原则涉及手术室与重症监护病房之间的患者交接、复苏、脊髓损伤的预防和管理，以及重要的神经、呼吸、心血管、肾脏、胃肠道和血液学方面的考虑因素。了解预期的术后病程有助于更早地识别与该病程的偏差，并增加成功挽救患者不良后果的可能性。胸腹主动脉瘤修复术后要取得良好的治疗效果，需要在围手术期、手术期和术后护理阶段都注重细节。
