手术室中的颈动脉内膜切除术CarotidEndarterectomy(CEA)日照市人民(rénmín)医院神经外科张玉海第一页，共六十一页。国家(guójiā)远程卒中中心、脑防委CEA培训基地、北京市脑血管病中心第二页，共六十一页。外科(wàikē)治疗相关问题•麻醉(mázuì)方式（GALAtrial）•术式介绍----标准CEA（传统CEA）----翻转式CEA•护士协作•并发症的预防第三页，共六十一页。OperationroomteampositionduringCEA.SSurgeon,aSassistingsurgeon,Neneurophysiologist；Aanaesthesiologist；Nnurse；Mmicroscope团队配置(pèizhì)及体位第四页，共六十一页。Supineposition;Headup:toreducecervicalvenouspressure;.Headisplacedonaring,withasandbagundertheshoulders;V.Exposingthefulllengthofthesternomastoidmuscle;手术(shǒushù)体位要求第五页，共六十一页。手术(shǒushù)切口第六页，共六十一页。麻醉(mázuì)篇麻醉平稳及适时调整(tiáozhěng)血压至关重要第七页，共六十一页。麻醉(mázuì)方式全麻(quánmá)：----Generalanaesthesiahasseveraladvantages,includingeasiersurgicalmanoeuvres,handlingofcomplicationsandeasierpatientmonitoring.局麻：----local/regionalanaesthesiadecreasesthenumberofmedicalcomplicationsattheexpenseofneurologicalcomplications.第八页，共六十一页。Generalanaesthesiaversuslocalanaesthesiaforcarotidsurgery(GALA):amulticentre,randomisedcontrolledtrialMethod:aparallelgroup,multicentre,randomisedcontrolledtrialof3526patientswithsymptomaticorasymptomaticcarotidstenosisfrom95centresin24countries.----general(n=1753)orlocal(n=1773)anaesthesia;----stroke(includingretinalinfarction),myocardialinfarction,ordeathbetweenrandomisationand30daysaftersurgery;Conclusion:Thetwogroupsdidnotsignificantlydifferforqualityoflife,lengthofhospitalstay,ortheprimaryoutcomeintheprespecifiedsubgroupsofage,contralateralcarotidocclusion,andbaselinesurgicalrisk.两个组在生活质量、住院时间、预设不同年龄组的结果(jiēguǒ)、双侧颈动脉闭塞和手术风险等方面均无显著差异。第九页，共六十一页。麻醉(mázuì)的不可替代性•掌握术前有无心脏疾病，缺血性尤为重要•术前的基础血压(xuèyā)，要明确•麻醉平稳后开始手术前的血压，记录定标•临时阻断后可能需要短时升压至要...
