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ID:30995916
大小:78.00 KB
页数:3页
时间:2019-01-05
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1、1.Apatientwithanonobstructingcarcinomaofthesigmoidcolonisbeingpreparedforelectiveresection.Tominimizetheriskofpostoperativeinfectiouscomplications,yourplanningshoudincludea.Asinglepreoperativeparenteraldoseofantibioticeffectiveagainstaerobesandanaerobes.b・Avoidanceoforala
2、ntibioticstopreventemergenceofClostridiumdifficile・c.Postoperativeadministrationfor2-4daysofparenteralantibioticseffectiveagainseaerobesandanaerobesd・Postoperativeadministrationfor5-7daysofparenteralantibioticseffetiveagainstaerobesandanaerobese.Operativetimelessthan5h2.A
3、70-year-oldmanwithaorticandmitralvalvularegurgitationundergoesanemergencysigmoidcolectomyandendcolostomyforperforateddivcrticulitis.Hispostoperativecourseiscomplicatedbyamyocardialinfarctionandatrialfibrillation.Fourweekslater,hehasimprovedandrequestselectivecolostomyclos
4、ure.Youwouldrecommenda.Discontinuationofantiarrhythmicandantihypertensivemedicationsonthemorningofsurgeryb.Discontinuationofbeta-blockingmedicationsonthedaypriortosurgeryc・Controlofcongestiveheartfailurewithdiureticsanddigitalisinseverecasesd.Administrationofprophylactica
5、ntibiotics,otherthanampicillinandgentamicin,forpatientswithvalvularheartdiseasewhoareundergoinggastrointestinalprocedurese.Postponementofelectivesurgeryfor6-8wkafterasubendocardialmyocardialinfarction.3.A65-ycar-oldmanundergoesatechnicallydifficultabdominoperinealresectio
6、nforarectalcancerduringwhichhereceivesthreeunitsofpackedredbloodcells,Fourhourslaterintheintensivecareunitheisbleedingheavilyfromhisperinealwound.Emergencycoagulationstudiesrevealnormalprothrombin,partialthromboplastin,andbleedingtimes.Thefibrindegradationproductsarenotel
7、evatedbuttheserumfibrinogencontentisdepressedandtheplateletcountis70,000/Ul.Themostlikelycauseofthebleedingisa.Delayedbloodtransfusionreactionb.Autoimmunefibrinolysisc.Ableedingbloodvesselinthesurgicalfieldd.FactorVIIIdeficiencyc.Hypothermiccoagulopathy4.A78-year-oldmanwi
8、thahistoryofcoronaryarterydiseaseandanasymptomaticreducibleinguinalherniarequestsanelectivehermi
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