器 官 移 植 麻 醉双语PPT讲稿.ppt
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1、器 官 移 植 麻 醉双语1第1页,共31页,编辑于2022年,星期六Anesthesia for Kidney TransplantationKidneys are the most common major organ transplanted,the success of kidney transplantation,which is largely due to advances in immunosuppressive therapy,has greatly improved the quality of life for patients with end-stage renal
2、disease.2第2页,共31页,编辑于2022年,星期六uIndications Patients with end-stage renal diseases and dependent on dialysis(透透析)析)for a long time.3第3页,共31页,编辑于2022年,星期六uCharacteristic of Pathophysiology Changes of electrolyte and acid-base balance Water intoxication(水水中中毒毒),hyperkalemia(高高 钾钾),hyponatremia(低低 钠钠),h
3、ypernatremia(高高钠钠)and metabolic acidemia(代酸)(代酸).4第4页,共31页,编辑于2022年,星期六 Cardiovascular Hypertension(高高血血压压)Renal ischemia,sodium retention and abnormalities in the renin-agiotension system result in systemic hypertension.Uremic cardiac disease myocardiosis(心心肌肌炎炎),pericarditis(心心包包炎炎),left ventricul
4、ar hypertrophy)(左左室室肥肥大大),coronary ischemia(冠冠脉脉缺缺血血),angiosclerosis(血血管管硬硬化)化).5第5页,共31页,编辑于2022年,星期六Potentialcongestiveheartfailure(潜在性充血性心力衰竭)(潜在性充血性心力衰竭)andpulmonaryedema(肺水(肺水肿)肿)arrhythmia(心律失常)(心律失常)6第6页,共31页,编辑于2022年,星期六 Hematologic Bone marrow suppression,decreased erythropoietin production
5、,decreased erythrocyte production,increased deformation erythrocyte production and increased bleeding tendency Anemia(贫血贫血).Liver disease coagulation factor,Uremia(尿尿毒毒症症)and using of heparin coagulation disorder,bleeding time .7第7页,共31页,编辑于2022年,星期六 Other changes Nausea(恶恶心心),vomit(呕呕吐吐),anorexia(厌
6、厌食食),diarrhoea(腹腹泻泻),ascites(腹腹水水)and gastric dilatation(胃扩张)(胃扩张).Infection(感染)(感染).Hypoproteinemia(低低 蛋蛋 白白 血血 症症),hyperglycemia(高血糖症)(高血糖症).8第8页,共31页,编辑于2022年,星期六u Evaluation and preparation before anesthesia Preanesthetic evaluation This assessment includes a patient history,a physical examinati
7、on and any indicated lab tests,classifying the patient according to the ASA physical status scale completes the assessment.9第9页,共31页,编辑于2022年,星期六General condition Patients are often combined with h y p o p r o t e i n e m i a ,a n e m i a,coagulation disorder and fluid,electrolyte and acid-base dist
8、urbance and so on.Concurrent diseases Cardiovascular,pulmonary,cerebral,hepatic and other diseases are commonly coexisted.Status of immunosuppression(免免疫疫抑抑制制)and infection(感染)(感染).10第10页,共31页,编辑于2022年,星期六Preanesthetic preparationCare of donor kidney Kidney should have good circulation perfusion bef
9、ore being separated from donor,warm ischemia time and cold ischemia time should be minimized,separated kidney should be frozen for preservation in reason,transplanted kidney should have good perfusion after rebuilding circulation and renal function should be recovered in time.11第11页,共31页,编辑于2022年,星期
10、六Dialysis(透透 析析)is the most important preparation before operation.Dialysis often precedes transplan tation to correct volume or electrolyte derangements.Hemodialysis(血血液液透透析析)is more effective than peritoneal dialysis(腹腹膜膜透透析)析).12第12页,共31页,编辑于2022年,星期六 Blood transfusion(输输 血血)Blood transfusion sho
11、uld generally be given only to severely anemic patients(hemoglobin/血血色色素素 6-7g/dl)or when significant intraoperative blood loss is expected.Controlling infection.13第13页,共31页,编辑于2022年,星期六Treatment of complication(Hypertension,cardiac function ,fluid,electrolyte and acid-base disturbance and so on)Fas
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