烟雾病伴蛛网膜下腔出血产妇行剖宫产术围手术期管理1例

2019-04-17 李纯青 曲元 国际麻醉学与复苏杂志

产妇,28岁,身高160 cm,体重60kg,以“停经37+4周,头痛2周,加重1d”入院。8岁时曾发生脑梗死(脑梗),诊断为烟雾病,诊断过程不详,治疗后好转,10岁时再次发生脑梗,出现言语不清症状并遗留后遗症。

1.病例报告
 
1.1病史回顾
 
1.1.1病史
 
产妇,28岁,身高160 cm,体重60kg,以“停经37+4周,头痛2周,加重1d”入院。8岁时曾发生脑梗死(脑梗),诊断为烟雾病,诊断过程不详,治疗后好转,10岁时再次发生脑梗,出现言语不清症状并遗留后遗症。
 
产妇入院2周前自觉轻度头痛,未就诊,入院前1d头痛加剧不能忍受,伴恶心、呕吐4次,就诊外院,BP200mmHg/110mmHg(1mmHg=0.133kPa),查尿蛋白(++),行头颅CT检查示:①蛛网膜下腔出血;②左侧额顶部见小片状软化灶。急诊转入我院,神志清楚,口齿欠清,BP125mmHg/80mmHg,HR84次/min;实验室检查示:血糖6.20mmol/L,脑钠肽153.00ng/L,尿蛋白(+),酮体(++),余未见明显异常。
 
紧急行头颅MRI示:双侧颈内动脉颅内段、椎动脉颅内段及基底动脉管腔广泛纤细,双侧大脑前、中动脉主干未见显影,伴周围多发侧支循环形成,考虑烟雾病。
 
1.1.2诊断及手术方式
 
入院诊断:宫内孕37+4周,G1P0,头位未产;蛛网膜下腔出血;烟雾病;重度子痫前期。产妇12:00入院,经紧急全院会诊,拟在全身麻醉下行急诊子宫下段剖宫产术终止妊娠。
 
1.2麻醉经过
 
1.2.1麻醉过程
 
产妇15:30入手术室,术前禁食时间超过8h,禁水时间超过6h。入室后常规监测ECG、SpO2、BIS,建立上肢静脉通道,局部麻醉下行左侧桡动脉穿刺置管监测有创动脉压。入室无创血压160mmHg/105mmHg,HR63次/min,SpO2 100%,休息5min后有创动脉血压130mmHg/90mmHg。预充氧10min且产科消毒铺巾准备就绪后行快速序贯诱导:静脉注射丙泊酚(生产批号:16LG8220,北京费森尤斯卡比医药)200mg,靶控输注瑞芬太尼(生产批号:6170909,宜昌人福药业有限责任公司)效应室浓度3μg/L,意识消失即刻压迫环状软骨,同时静脉注射罗库溴铵(生产批号:No19384,Hameln Pharmaceuticals GmbH,美国)50mg,肌肉松弛药起效后行气管插管,插管成功使气囊充气后停止压迫环状软骨,整个过程不使用正压辅助通气。
 
全身麻醉诱导过程中有创动脉血压波动于140~169mmHg/79~109mmHg。麻醉维持:靶控输注瑞芬太尼,效应室靶浓度2~3μg/L,持续输注丙泊酚4~8mg·kg-1·h-1,胎儿取出后分次追加舒芬太尼(生产批号:170150,IDT Biologika GmbH,德国)20μg。术中BP波动120~169mmHg/68~109mmHg,HR维持于53~105次/min。当SBP>160mmHg时静脉注射尼卡地平(生产批号:N060Y01,安斯泰来制药有限公司)0.1~0.2mg进行降压处理,全程BP未出现明显下降,未使用升压药。
 
术中BIS维持在40~60。调节呼吸参数:潮气量500ml、呼吸频率12~14次/min、吸气和呼气时间比值1.0∶1.5~1.0∶2.0,维持PETCO2和PaCO2在正常范围。手术过程顺利,15:59剖出一活女婴,2770g,新生儿1min、5min Apgar评分分别为7、10分。术中补充晶体液1000ml,出血量200ml,尿量150ml。术毕接患者自控静脉镇痛泵,配方为舒芬太尼125μg,生理盐水稀释至100ml,背景剂量1ml/h,负荷剂量2ml,锁定时间8min。术后保留气管导管入SICU。
 
1.2.2术后情况
 
入SICU后复查头颅CT示:蛛网膜下腔出血,双侧额顶叶白质水肿。处理措施:持续泵注尼莫地平预防血管痉挛、给予甘露醇行降颅压处理、SBP过高时(SBP>160mmHg)间断静脉注射乌拉地尔(拔管后改口服苯磺酸氨氯地平片)。术后第2天拔除气管导管,术后第7天转回普通病房。期间BP波动120~150mmHg/70~100mmHg,未再出现神经系统症状。神经外科会诊建议产妇行脑血管造影以进一步明确脑血管病变,决定是否手术治疗,产妇及家属拒绝。术后第11天出院。遗留右侧上、下肢肌力减退(肌力4级)。
 
2.讨论
 
2.1产妇疾病
 
烟雾病以双侧颈内动脉末端或大脑前、中动脉近端进行性狭窄或闭塞、脑底异常血管网形成为特征。该病原因不明,在儿童临床表现以缺血为主,成年人则以出血为主,包括脑内出血、脑室内出血和蛛网膜下腔出血。烟雾病导致蛛网膜下腔出血的原因主要包括:异常增生的烟雾状血管破裂,颅内动脉瘤破裂(异常血流动力学改变导致的新生侧支血管形成微小或假性动脉瘤或脑血管真性动脉瘤)等。本例产妇烟雾病史未治疗,儿童期有过两次脑梗史,成年后于妊娠晚期出现蛛网膜下腔出血并发症,同时合并重度子痫前期,后者可能加重蛛网膜下腔出血,使病情更为复杂。
 
2.2分娩方式及麻醉方法选择
 
该产妇已出现脑卒中并发症,属椎管内麻醉禁忌,因此采用全身麻醉。对于具有颅内出血低风险的烟雾病产妇(如无脑卒中病史且接受过再血管化外科手术治疗者),分娩方式可选择自然分娩,但需要给予充分镇痛(如硬膜外镇痛),避免分娩痛所造成的循环波动及过度通气。
 
对于具有颅内出血高风险且未接受过外科手术治疗的产妇,宜选择剖宫产终止妊娠。麻醉方法可采用蛛网膜下腔-硬膜外联合麻醉、硬膜外麻醉或全身麻醉。椎管内麻醉可能造成低血压、减少脑部血供、增加脑梗的风险;全身麻醉的插管反应所引起的高血压则会增加颅内出血的风险。通过提高麻醉技术,尽量避免麻醉方式造成的循环剧烈波动是关键。椎管内麻醉应控制麻醉平面不能过高,全身麻醉则通过合理用药降低插管反应,同时需要防治产科麻醉中常见的仰卧位低血压综合征。另外,对于选择全身麻醉的孕晚期产妇,即使术前禁食、禁水时间足够,但由于其贲门括约肌松弛、腹内压增加、受子宫推挤呈水平位及排空延迟等生理原因,仍为反流误吸的高危人群,因此全身麻醉诱导应采用快速序贯诱导。
 
2.3麻醉药物的选择
 
本例麻醉诱导使用丙泊酚和瑞芬太尼。由于意识消失的同时剖宫产手术开始,气管插管与切皮刺激的共同作用下BP必然急剧升高,单纯给予丙泊酚无法有效抑制疼痛反应,因而需合并使用超短效阿片类药物瑞芬太尼。瑞芬太尼可透过胎盘屏障,但能够在新生儿体内快速代谢和重分布,有Meta分析证实,瑞芬太尼可以安全应用于剖宫产手术的全身麻醉诱导,对新生儿无明显不良影响。
 
虽然也有研究发现瑞芬太尼用于全身麻醉诱导可能造成新生儿1min Apgar评分降低,但对5min及之后的Apgar评分、正压辅助通气和气管插管的发生率方面没有明显影响。麻醉维持采用全凭静脉麻醉:持续丙泊酚+瑞芬太尼、间断追加舒芬太尼。研究表明,丙泊酚可明显增加大脑局部皮质血流水平并降低颅内压,具有潜在的脑缺血保护作用。术中使用足量的阿片类镇痛药消除疼痛刺激,降低脑氧代谢。术毕接舒芬太尼术后镇痛泵,提供完善的术后镇痛,防止术后疼痛造成的循环波动。因吸入麻醉药可以扩张脑血管、增加脑血流量,因而不宜用于可能存在脑水肿及颅内高压的患者。
 
2.4循环管理
 
对于合并烟雾病的产妇,围生期避免循环剧烈波动尤其关键。BP急剧升高可能导致颅内出血,BP急剧下降可能导致病变血管痉挛,发生脑梗。该例产妇入院前已发生蛛网膜下腔出血并发症,对于蛛网膜下腔出血产妇的BP控制应当根据产妇年龄、基础BP水平、其他合并症等综合考虑。目前尚无病例对照研究明确表明急性蛛网膜下腔出血产妇控制BP对再出血的影响,对于动脉瘤破裂导致的蛛网膜下腔出血一般要求SBP<160mmHg;但同时要避免过度降压加重脑灌注不足,MAP应控制在90mmHg以上。
 
本例产妇麻醉诱导前的基础BP130mmHg/90mmHg左右,术中BP尽量控制在基础水平或稍高水平,最低为120mmHg/68mmHg且术中出血量不多,避免容量过负荷及使用升压药。术中在保证合适麻醉深度的前提下出现的BP过高(SBP>160mmHg),给予小剂量尼卡地平0.1~0.2mg进行降压处理,避免过度降压,以防降低脑灌注、加重脑缺血。
 
2.5呼吸管理
 
针对该病例,术中通过调节其机械通气呼吸参数,维持PETCO2和PaCO2在正常范围。研究发现,与清醒时通气状态相比,PET CO2 20mmHg时脑血流量减少57.75%,而PET CO2 40mmHg和20mmHg时脑血流量比PETCO2 30mmHg时分别增加和减少了29.2%和11.3%。过度通气及低碳酸血症可造成脑血管收缩、脑血流量减少,从而降低病变血管支配区的血供;而通气不足及高碳酸血症则导致脑血管扩张、脑血流量增加,致使颅内压升高,进一步加重颅内高压。因此,对于烟雾病伴蛛网膜下腔出血,上述两种情况都应避免。
 
2.6监测
 
行有创血压监测及时掌握及调整循环变化。BIS监测保证适宜的麻醉深度。
 
2.7术后管理
 
术后管理要点是防止再出血和脑血管痉挛。维持循环稳定,必要时使用血管活性药;持续泵注尼莫地平防治脑血管痉挛;控制颅内压,适当降低颅内压。
 
3.结语
 
综上所述,烟雾病伴蛛网膜下腔出血的产妇病情复杂,围生期麻醉管理至关重要。总体原则是保证脑血流量及脑灌注的同时避免加剧颅内高压及脑氧耗量。加强监测,维持循环、呼吸系统稳定,采取全身麻醉方法,合理选择全身麻醉药物,充分镇痛镇静的同时避免循环剧烈波动,必要时辅以血管活性药。
 
原始出处:

李纯青,曲元.烟雾病伴蛛网膜下腔出血产妇行剖宫产术围手术期管理1例[J].国际麻醉学与复苏杂志,2018,(4):354-357. 

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1241437, encodeId=3bd3124143e6f, content=<a href='/topic/show?id=f65b6e13468' target=_blank style='color:#2F92EE;'>#烟雾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67134, encryptionId=f65b6e13468, topicName=烟雾病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Sun Aug 28 03:28:56 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053854, encodeId=807a2053854f3, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sat Oct 05 06:19:00 CST 2019, time=2019-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812631, encodeId=0d561812631f6, content=<a href='/topic/show?id=990a9005092' target=_blank style='color:#2F92EE;'>#行剖宫产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90050, encryptionId=990a9005092, topicName=行剖宫产)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Feb 10 06:19:00 CST 2020, time=2020-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654474, encodeId=490616544e4eb, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Tue Jul 16 15:19:00 CST 2019, time=2019-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392854, encodeId=076b139285472, content=<a href='/topic/show?id=84964065015' target=_blank style='color:#2F92EE;'>#围手术期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40650, encryptionId=84964065015, topicName=围手术期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Fri Apr 19 07:19:00 CST 2019, time=2019-04-19, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1241437, encodeId=3bd3124143e6f, content=<a href='/topic/show?id=f65b6e13468' target=_blank style='color:#2F92EE;'>#烟雾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67134, encryptionId=f65b6e13468, topicName=烟雾病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Sun Aug 28 03:28:56 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053854, encodeId=807a2053854f3, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sat Oct 05 06:19:00 CST 2019, time=2019-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812631, encodeId=0d561812631f6, content=<a href='/topic/show?id=990a9005092' target=_blank style='color:#2F92EE;'>#行剖宫产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90050, encryptionId=990a9005092, topicName=行剖宫产)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Feb 10 06:19:00 CST 2020, time=2020-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654474, encodeId=490616544e4eb, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Tue Jul 16 15:19:00 CST 2019, time=2019-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392854, encodeId=076b139285472, content=<a href='/topic/show?id=84964065015' target=_blank style='color:#2F92EE;'>#围手术期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40650, encryptionId=84964065015, topicName=围手术期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Fri Apr 19 07:19:00 CST 2019, time=2019-04-19, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1241437, encodeId=3bd3124143e6f, content=<a href='/topic/show?id=f65b6e13468' target=_blank style='color:#2F92EE;'>#烟雾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67134, encryptionId=f65b6e13468, topicName=烟雾病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Sun Aug 28 03:28:56 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053854, encodeId=807a2053854f3, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sat Oct 05 06:19:00 CST 2019, time=2019-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812631, encodeId=0d561812631f6, content=<a href='/topic/show?id=990a9005092' target=_blank style='color:#2F92EE;'>#行剖宫产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90050, encryptionId=990a9005092, topicName=行剖宫产)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Feb 10 06:19:00 CST 2020, time=2020-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654474, encodeId=490616544e4eb, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Tue Jul 16 15:19:00 CST 2019, time=2019-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392854, encodeId=076b139285472, content=<a href='/topic/show?id=84964065015' target=_blank style='color:#2F92EE;'>#围手术期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40650, encryptionId=84964065015, topicName=围手术期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Fri Apr 19 07:19:00 CST 2019, time=2019-04-19, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1241437, encodeId=3bd3124143e6f, content=<a href='/topic/show?id=f65b6e13468' target=_blank style='color:#2F92EE;'>#烟雾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67134, encryptionId=f65b6e13468, topicName=烟雾病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Sun Aug 28 03:28:56 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053854, encodeId=807a2053854f3, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sat Oct 05 06:19:00 CST 2019, time=2019-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812631, encodeId=0d561812631f6, content=<a href='/topic/show?id=990a9005092' target=_blank style='color:#2F92EE;'>#行剖宫产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90050, encryptionId=990a9005092, topicName=行剖宫产)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Feb 10 06:19:00 CST 2020, time=2020-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654474, encodeId=490616544e4eb, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Tue Jul 16 15:19:00 CST 2019, time=2019-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392854, encodeId=076b139285472, content=<a href='/topic/show?id=84964065015' target=_blank style='color:#2F92EE;'>#围手术期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40650, encryptionId=84964065015, topicName=围手术期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Fri Apr 19 07:19:00 CST 2019, time=2019-04-19, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1241437, encodeId=3bd3124143e6f, content=<a href='/topic/show?id=f65b6e13468' target=_blank style='color:#2F92EE;'>#烟雾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67134, encryptionId=f65b6e13468, topicName=烟雾病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Sun Aug 28 03:28:56 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053854, encodeId=807a2053854f3, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sat Oct 05 06:19:00 CST 2019, time=2019-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812631, encodeId=0d561812631f6, content=<a href='/topic/show?id=990a9005092' target=_blank style='color:#2F92EE;'>#行剖宫产#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90050, encryptionId=990a9005092, topicName=行剖宫产)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Feb 10 06:19:00 CST 2020, time=2020-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1654474, encodeId=490616544e4eb, content=<a href='/topic/show?id=5ab788e81d3' target=_blank style='color:#2F92EE;'>#蛛网膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88781, encryptionId=5ab788e81d3, topicName=蛛网膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=396c24497244, createdName=aliceclz, createdTime=Tue Jul 16 15:19:00 CST 2019, time=2019-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392854, encodeId=076b139285472, content=<a href='/topic/show?id=84964065015' target=_blank style='color:#2F92EE;'>#围手术期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40650, encryptionId=84964065015, topicName=围手术期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Fri Apr 19 07:19:00 CST 2019, time=2019-04-19, status=1, ipAttribution=)]

相关资讯

Radiology:烟雾病患者做了血运重建术后脑灌注怎么样?

本研究旨在验证动脉自旋标记(ASL)磁共振(MR)成像在识别烟雾病患者血运重建术后脑血流量(CBF)、侧支循环流量和吻合口通畅度的能力,并将结果发表在Radiology上。

SCI REP:Treg和Th17增多与烟雾病的发病机理相关

目前已经证实免疫炎症在烟雾病(MMD)的发病机理中起关键作用。然而,循环的Treg / Th17细胞MMD患者中,如何参与并导致该疾病发生,仍然不清楚。我们的研究结果表明循环的Treg参与了MMD的发病机制,并且是重要的因素。

烟雾病和烟雾综合征诊断与治疗中国专家共识

烟雾病是一种病因不明的、以双侧颈内动脉末端及大脑前动脉、大脑中动脉起始部慢性进行性狭窄或闭塞为特征,并继发颅底异常血管网形成的一种脑血管疾病。1969年,由日本学者Suzuki和Takaku首先报道。由于这种颅底异常血管网在脑血管造影图像上形似“烟雾”,故称为“烟雾病”。

Radiology:利用MR AccASL技术评估Moyamoya病其显示远端脑动脉及侧枝循环的的价值

目的:以DSA诊断作为金标,评估和比较AccASL-MRA和TOF-MRA两种成像方式在Moyamoya病中对脑动脉及侧枝循环显示的价值,并将结果发表在Radiology上。

迷雾样的烟雾病,似谜,似雾...

拨开“烟雾”,方见彩虹……