Cardiorespiratory and vascular dysfunction related to major reconstructive orthopedic surgery

被引:34
作者
Dahl, OE [1 ]
机构
[1] Univ Oslo, Ullevaal Hosp, Dept Orthopaed, Res Forum, N-0407 Oslo, Norway
来源
ACTA ORTHOPAEDICA SCANDINAVICA | 1997年 / 68卷 / 06期
关键词
D O I
10.3109/17453679708999038
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Major orthopedic reconstructive surgery is highly traumatic and may be associated with serious perioperative cardiorespiratory and vascular complications which occasionally may be fatal. These complications are commonest in patients receiving cemented hip prostheses following femoral neck fractures. The etiology is multifactorial. Bone traumatization induces activation of the hemostatic system, i.e., thrombin generation, in venous blood draining the operation area. When this activated blood passes the lung, more thrombin is generated and the blood becomes hypercoagulable and causes fibrin-formation in the lung vessels, with trapping of cellular debris. Thrombin has many hormone-like effects beyond its function in the coagulation cascade sys- tem. It may increase vein wall permeability and cause constriction of vessels, which increases blood pressure in the lung. In addition, impaction of bone cement to fill bone cavities or to fix prostheses causes additional mechanical trauma and further release of procoagulant substances into venous blood. Further, release of the cytotoxic chemical methylmethacrylate monomer into venous blood is super-imposed on the thrombin-primed hemostatic disturbances in the lung microvasculature. All these effects may finally induce hemodynamic insufficiency, which occasionally may be fatal. To prevent these adverse reactions, thrombin activity should be reduced and impaction of bone cement minimized.
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页码:607 / 614
页数:8
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