围手术期处理-英语课件

1、Perioperative Management,Perioperative period,Definition not well established Importance directly related to the outcome of surgery itself Composition preoperative preparation & postoperative management,1. Elective surgery 2. Restrictive surgery 3. Emergent surgery,Preoperative Preparation,The principle Different preparation for different operation The classification of operations according to the characteristics of operations,To confirm the diagnosis To assess the risk of operation To assess th

2、e general condition and function of important organs To evaluate the patients endurance to the operation and risk of operation,Preoperative Assessment,Essential steps in preoperative assessment and preparation,History taking Physical examination Collating pre-admission information about diagnosis Arranging any further diagnostic investigation Making special preparations for the particular operation Investigating any intercurrent or occult illness suggested by medical clerking,Essential steps in

3、preoperative assessment and preparation,Discussing the operation with the patient and his family and obtaining signed consent Marking the operation site Making arrangements for the operation with the operating theatre staff Arranging and informing the anaesthetist Prescribing medication prophylactic antibiotics etc. Planning rehabilitation and convalescence,Psychological preparation talk frankly and appropriately to patients Physiological preparation,Adaptive exercise Transfusion Prevention of i

4、nfection Gastro-intestinal tract preparation Maintenance of fluid, electrolyte and nutrition,General Preparation,Malnutrition and dysfunction of immune system,Malnutrition dramatically increases the morbidity and mortality Preoperative nutritional support is more valuable,Specific Preparation,Hypertension,Mild-to-moderate essential hypertension systolic pressure 180mmHg diastolic pressure 110mmHg,At minimal risk of cardiac complication,Antihypertensive drugs should be used all time Sudden withdr

5、awal of drugs is dangerous,Severe or poorly controlled hypertension,At high risk of perioperative cardiac failure or stroke. This type of patients should not undergo general anaesthesia and surgery until adequately treated. The blood pressure should be reasonably controlled under 160/100 mmHg.,Cardiovascular disease,Ischaemic heart disease Cardiac failure Arrhythmias Valvular heart disease Cerebrovascular disease,Angina,Previous infarction,Stable angina poses little increased risk during operati

6、on but unstable angina is as dangerous as recent myocardial infarction,The risk of reinfarction is about 30% if an operation is performed during the first 3 months At 6 months the risk is about 10 15% which may be acceptable for important elective surgery,Adequate preparation for heart disease,To correct the fluid and electrolyte imbalance. To correct anaemia through several blood transfusion with small amount. To control the cardiac arrhythmias. (Atrial fibrillation, Tachycardia, Bradycardia),R

7、espiratory dysfunction,Respiratory complications occur in up to 15% of surgical patients and are the leading cause of postoperative mortality in the elderly.,Risk factors for respiratory complication,Chronic obstructive pulmonary or airways disease (Chronic bronchitis, emphysema, bronchiectasis, pneumoconiosis, pulmonary tuberculoses) Cigarette smoking Current respiratory infections Asthma,Preoperative investigation of respiratory disease,A chest X-ray, CT scan if necessary EKG Spirometer Blood

8、gas measurement,Perioperative management of respiratory disease and high risk patients,1. Preoperative physiotherapy teaching the patient breathing exercises and correct posture 2. Drug therapy Theophyllines Prophylactic antibiotics Preoperative bronchodilator Adequate hydration,3. Encourage to stop smoking from the time of book for elective surgery 4. Alternation methods of anaesthesia Local, regional or spiral anaesthesia should be considered 5. Early postoperative physiotherapy to enhance dee

9、p breathing, coughing and general mobility,Liver disorder,The tolerance to operation depends upon the severity of liver function impairment. The liver function could be estimated by Child staging. Malnutrition, ascites and jaundice are contraindications except for emergency surgery.,Preoperative assessment and management,Serological test for HBV and HCV, full blood count, clotting screen and platelet count, plasma urea and electrolytes, bilirubin, transaminases, calcium, phosphate, gamma glutaryl transferase and albumin. When prothrombin time is prolonged, vitamin K should be given for several days before operation.,Renal disorders,Preoperative assessment plasma urea, electrolytes, creatinine and Bicarbonate should be checked Mild chronic renal failure Drugs should be given in smaller doses Fluid and electrolyte homeostasis Moderate-to-severe chronic renal failure Operations should be performed under haemodialysis,Disorders of Adrenal Function,Adrenal Insufficiency The mos

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