浙大医学院五年制围手术期处理节课.pptVIP

围手术期处理Management of Perioperative period 浙医一院肿瘤中心 滕理送 Pre-Op and Post-Op Care Preoperative preparation术前准备 Postoperative management术后处理 Postoperative complications并发症处理 Emergency operation Trauma with massive bleeding acute intracranial hematoma with brain hernia Acute arterial embolism Abdominal hollow cavity organ rupture or perforation Bowel obstruction with blood insufficiency Confine/Selective Operation Confine operation Radical dissection of malignancy Selective operation Hernia repair, benign tumor resection Preoperative general preparation Operation agreement Smoking cessation Digestive tract preparation Antibiotics Nutritional supplement Blood preparation Skin preparation Diet before surgery Preoperative assessment Cardiac risk Pulmonary risk Hepatic risk Nutritional risk Metabolic risk Cardiacvascular risk Ejection fraction, 35% Arrythmia, ventricular rate100 Myocardial infarction, 6 month later Goldman’s index Factors contribute to cardiac risk Jugular venous distention, Recent MI Premature ventricular contraction5/min, rhythm other than sinus, aortic valvular stenosis, age70,chest or abdominal surgery, Emergency ECG, DCG, Ultrasonic/heart pulmonary risk Smoking COPD Pulmonary function test Blood gas High PCO2 and low FEV1 Hepatic risk Bilirubin, serum albumin, Prothrombin time, ascitis, encephalopathy 40% mortality with either Bilirubin2, Albumin30,PT16 or encephalopathy 80%-85% mortality with three of above present, or Bilirubin4 or Albumin20,or blood amnonia 150 Nutritional risk Loss of 20% of body weight in months Serum Albumin3 Anergy to skin antigen Serum transferrin 200mg/dl Nutritional support preferably via gut at least 4-5 days Metabolic risk Hyperglycemia Correction of acidosis change to insulin injection a little bit higher than normal is preferable 5.6~11.2mmol/L Test :blood glucose (Fasting+ after meal) Postoperative management Monitor Vital sign (HR,R,T,Bp,SpO2) General appearance( alertness, distress, pain,) pain Urine