| Japanese |
|---|
| Title | 僧帽弁狭窄症の麻酔管理 |
|---|
| Subtitle | 総説 |
|---|
| Authors | 津田英照*, 中村秀三*, 篠崎正博*, 上田直行*, 小須賀健一** |
|---|
| Authors(kana) | |
|---|
| Organization | *久留米大学医学部麻酔学教室, **久留米大学医学部第2外科学教室 |
|---|
| Journal | 循環制御 |
|---|
| Volume | 5 |
|---|
| Number | 4 |
|---|
| Page | 419-432 |
|---|
| Year/Month | 1984/ |
|---|
| Article | 報告 |
|---|
| Publisher | 日本循環制御研究会 |
|---|
| Abstract | 「I. はじめに」開心術の急速な進歩とmortalityの改善は麻酔学の進歩によるところが大であるといっても過言ではなかろう. しかし比較的安全に使用し得る麻酔剤あるいは麻酔手技は画一的な麻酔法を生みだし各々の疾患のもつ病態への認識を怠りがちにし, きわめて感覚的なリスクの判定と汎用される麻酔法の応用というマスプロ的な麻酔を産みだしている. だが, 益々, 高齢化, 重症化する後天性心疾患, 益々複雑な先天性心疾患への外科治療の挑戦は, 疾患各々のもつ病態の定量的把握を出発点とした, より稠密繊細な術中術後管理を要求する. 我々は, 前回, ファロー氏四徴症の麻酔管理と題し, 疾患特有の病態把握を前提とした管理法について論述したが, 今回は僧帽狭窄症をとりあげ, 麻酔医師として術前にいかに病態を把握し, 納得した形でどれだけ術中管理を行いうるかを自問自答し論述してみたい. 「II. 僧帽弁狭窄症のPhysiological consequence」狭窄による順流障害のprototypeとしてリウマチ性弁病変による僧帽弁狭窄例を考えてみると, リウマチ性病変は弁尖の肥厚短縮, 弁輪部の硬化に加えて心筋変化さらに他弁(大動脈弁, 三尖弁)への変化をももたらすとされる. |
|---|
| Practice | 基礎医学・関連科学 |
|---|
| Keywords | |
|---|
| English |
|---|
| Title | Anesthesiological Care of Mitral Stenosis in Open Heart Surgery |
|---|
| Subtitle | |
|---|
| Authors | Hideaki Tsuda*, Shuzo Nakamura*, Masahiro Shinozaki*, Naoyuki Ueda*, Kenichi Kosuga** |
|---|
| Authors(kana) | |
|---|
| Organization | *Dept. of Anesthesiology Kurume University School of Medicine, **Dept. of 2nd Surgery Kurume University School of Medicine |
|---|
| Journal | Circulation Control |
|---|
| Volume | 5 |
|---|
| Number | 4 |
|---|
| Page | 419-432 |
|---|
| Year/Month | 1984/ |
|---|
| Article | Report |
|---|
| Publisher | Japan Society of Circulation Control |
|---|
| Abstract | It is more than important to understand the pathophysiology of the disease when the complete care is necessary such as in the open heart surgery. We took Mitral Stenosis this time for example to discuss how can we be possibly reasonable to manage the patient during surgery. Preoperative evaluation of severity of Mitral Stenosis was tried on the basis of close observation of clinical symptoms such as re spiratory distress, RV dysfunction, systemic congestion and others. Anesthesiological consideration was also focused on how to prevent and treat tachycardia before C-P bypass, how to prevent systemic congestion, how to protect injured myocardium during aortic cross clamp, how to wean from C-P bypass. We feel, despite of decreasing number of mitral stenosis, intraoperative care request more sophisticated manner because older patient become having chance to be operated or reoperated. |
|---|
| Practice | Basic medicine |
|---|
| Keywords | Anesthesilogical care, Mitral stenosis, Open Heart surgery, Preoperative evalution, Intraoperative management |
|---|