|
Case 26. Thoracoscopic Lung Resection If the likelihood of an open thoracotomy is high, then patients will benefit from the preoperative placement of a thoracic epidural for postoperative pain control. The epidural may also be used during the intraoperative period to decrease intravenous use of narcotics and therefore, facilitate early endotracheal extubation of patients at termination of surgery.  1. pneumonectomy [ˌnjʊmə'nɛktəmi] n.肺切除术 2. decubitus [dɪ'kjʊbətəs] n. 卧姿，【医】褥疮 // decubitus ulcer: BEDSORE 3. anemic [əˈniːmɪk] adj.同“anaemic”贫血的；患贫血症的 relating to or affected with anemia Anemia [əˈniːmiə] n.【医】贫血；同“anaemia”Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. 4. central venous pressure (CVP) 中心静脉压 Central venous pressure (CVP) is mean vena caval or right atrial pressure, which, in the absence of tricuspid stenosis, equals right ventricular end-diastolic pressure. Disorders that increase diastolic pressures of the right side of the heart—left heart disease, lung disease, primary pulmonary hypertension, and pulmonic stenosis ( 肺动脉瓣狭窄) — all increase the CVP and make the neck veins abnormally conspicuous ( [kənˈspɪkjʊəs] adj.易见的；明显的). pulmonic [pʌl'mɒnɪk] adj.肺的；肺病的
5. axillary artery 腋动脉 Axillary [æksɪlərɪ] adj.【解】腋下的 → axilla [æk'sɪlə] n.【解】腋窝 The axillary artery is a blood vessel that provides the axilla, the lateral portion of the thorax, and the upper limb with oxygenated blood. It consists of three parts separated by the pectoralis minor,which lies superficially to the artery. Pectoralis [pek-tə-ˈrā-ləs], plural pectorales [ -ˌlēz] 胸肌 Pectoralis major 胸大肌, pectoralis minor 胸小肌 6. brachial plexus 臂神经丛 The brachial plexus [BRAY-key-elPLEK-sis] is a network of nerves that gives rise to all the motor and sensory nerves of the upper extremity.
7. a fiberoptic bronchoscopy 纤支镜 Fiberoptic [ˈfī-bər-ˌäp-tik] 光纤的 fiber-optic: of, relating to, or using fiber optics Bronchoscopy [b'rɒn'kəskəpɪ] n.〔医〕支气管镜检查 8. a vascular clamp 血管钳 A vascular clamp is a device surgeons use to prevent blood flowing into areas that are being operated on. They are also able to stem the flow ofblood from severed or ruptured vessels. The vascular clamps are manufactured in a variety of shapes and materials, typically high-grade surgical stainless steel and durable plastics. sever [ˈsevə(r)]v.割断；断绝 // Start a new life, sever the tie for good. 开始新生活，彻底斩断和他的关系。 9. stylette ( stī'let, stī-let' ) 管芯 10. extubation [ˌek-ˌst(y)ü-ˈbā-shən] : 拔管the removal of a tube especially from the larynx after intubation — called also detubation
11. a double-lumen endotracheal tube 双腔支气管导管 The most distal tip of double lumen tube is always the bronchial lumen. A left pneumonectomy will require a right-sided double-lumen tube for one lung ventilation. Otherwise, a left-sided double-lumen tube is preferred by most since it is easier to position than a right-sided double lumen tube. A double lumen endotracheal tube (DLT) is an endotracheal tube designed to isolate the lungs from one another anatomically and/or physiologically. Anatomical lung separation (this isolates a diseased lung from contaminating the non-diseased lung).
Univent endotracheal tube 单腔支气管导管 This is a single-lumen endotracheal tube with a built-in endotrachial blocker. Using fiberoptic bronchoscopy, the endochatreal blocker can be positioned into the desired bronchus to achieve one lung ventilation. The advantage of the Univent tube is that it is easier to place than the double lumen tube. The disadvantage are that suctioning of the nonventilated lung cannot be achieved and continuous positive airway pressure (CPAP) cannot be applied during one lung ventilation.
12. mainstem bronchus 主干支气管 Either of two (right and left) bronchi which continue fromthe trachea and in turn give rise to lobar (secondary) bronchi. 13. counterintuitive [ˌkaʊnt(ə)rɪnˈtjuːɪtɪv] adj.反常的 : contrary to what one would intuitively expect → counter-intuitive // A counterintuitive proposition is one that does not seem likely to be true when assessed using intuition, common sense, or gut feelings. 用直觉或常识来判断不太真实的，违反常理的 14. herniation [ˌhɜ:nɪ'eɪʃən] n.形成疝 → hernia [ˈhɜː(r)niə] n.疝；突出 15. iatrogenic [aɪˌætrə'dʒenɪk] adj. 医源性,由治疗引起的 induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures. 16. vasculature ['væskjʊlətʃə(r)] n.脉管系统 the blood vessels or arrangement of blood vessels in an organ orpart.
13. barotrauma ['bærətrɔ:mə] n.气压伤；气压损伤 : injury of a body part or organ as a result of changes in barometric pressure Barometer [bəˈrɒmɪtə(r)] n.晴雨表；气压计；an instrument for measuring air pressure to show when the weather will change（显示经济、社会、政治变化的）晴雨表 something that shows the changes that are happening in an economic, social or political situation // So worker unrest in Iran is a good barometer of the stress that workers arefeeling. 因此，伊朗的工人骚乱是工人所感受到压力的计量表。 → Barometric [ˌbærə'metrɪk] adj.测定气压的 14. theoretical [ˌθɪəˈretɪk(ə)l] adj.理论上的；理论上存在的 concerned with the ideas and principles on which a particularsubject is based, rather than with practice and experiment 15. bleomycin 博莱霉素 [bli':əʊmi:sɪn] n.博莱霉素；〔药〕博来霉素 Bleomycin belongs to a subfamily of glycopeptide ( [glaɪkəʊ'peptaɪd] n.糖肽) antibiotics and is utilized primarily as an antineoplastic ( ['æntɪˌni:əʊ'plæstɪk] adj.抗肿瘤的n.抗肿瘤药) agent. Busulfan [b'ju:zəlfæn] n.白消安；马利兰；Busulfan is a synthetic derivative of dimethane-sulfonate with antineoplastic and cytotoxic properties.
16. nebulization [ˌnebjʊlaɪ'zeɪʃən] n.雾化；〔物〕喷雾(作用)；喷雾法 Nebulize ['nebjʊˌlaɪz] v.喷雾； Nebulizer ['nebjʊlaɪzə] n.喷雾器 17. reexpand the lungs 再次膨肺 re-expand un.再膨胀 18. cardiac dysrhythmias 心脏节律障碍 dysrhythmia /dɪsˈrɪðmiə/ n. 节律障碍 19. atrial fibrillation [病]心房颤动  Clinical Pearls 1. It is important to thoroughly evaluate the patient undergoing lung surgery to determine the risk for anesthesia and surgery. 2. Early detection and treatment of lung cancer offers better outcome. If time permits, then patient’s medical problems need to be optimized prior to surgery. 3. For patients scheduled for lung resection surgery, especially with lobectomy and pneumonectomy, it is important to determine whether or not the patient has enough pulmonary reserve to undergo the surgical procedure. Pulmonary functions tests, room air arterial blood gas, split lung function test, and pulmonary artery balloon-occlusion test can help predict patient’s postoperative outcome after lung resection surgery, and are especially important prior to a pneumonectomy.
** The rationale of regional lung function testsis that global pulmonary function is irrelevant post-resection. Regional perfusion tests (using IV 133Xe) allow one to examine the relative perfusion of each lung. Insoluble, inhale d radioactive-labeled gasses (xenon,99m-technetium) can be similarly used to conduct regional ventilation tests. The most “functional” split-lung function test is the bronchial balloon occlusion test, in which the segment to be resected is blocked and traditional pulmonary function tests are then repeated (and compared to the original) Case Files: Anesthesiology 学习笔记(103)胸腔镜下肺切除术2. Case Files: Anesthesiology 学习笔记(102)胸腔镜下肺切除术1. Case Files: Anesthesiology 学习笔记(101)慢性阻塞性肺病3. |
|
|
