《器官移植麻醉双语》PPT课件

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1、器官移植麻醉OrganTransplantation湘雅医院麻醉科张海萍1AnesthesiaforKidneyTransplantationKidneysarethemostcommonmajororgantransplanted，thesuccessofkidneytransplantation，whichislargelyduetoadvancesinimmunosuppressivetherapy，hasgreatlyimprovedthequalityoflifeforpatientswithend-stagerenaldisease.2Indication

2、sPatientswithend-stagerenaldiseasesanddependentondialysis（透析）foralongtime.3CharacteristicofPathophysiologyChangesofelectrolyteandacid-basebalanceWaterintoxication（水中毒），hyperkalemia（高钾），hyponatremia（低钠），hypernatremia（高钠）andmetabolicacidemia（代酸）.4CardiovascularHypertension（高血压）Renalischem

3、ia，sodiumretentionandabnormalitiesintherenin-agiotensionsystemresultinsystemichypertension.Uremiccardiacdiseasemyocardiosis（心肌炎），pericarditis（心包炎），leftventricularhypertrophy）（左室肥大），coronaryischemia（冠脉缺血），angiosclerosis（血管硬化）.5Potentialcongestiveheartfailure（潜在性充血性心力衰竭）andpulmonaryedema（

4、肺水肿）arrhythmia（心律失常）6HematologicBonemarrowsuppression,decreasederythropoietinproduction,decreasederythrocyteproduction,increaseddeformationerythrocyteproductionandincreasedbleedingtendencyAnemia(贫血).Liverdiseasecoagulationfactor，Uremia(尿毒症)andusingofheparincoagulationdisorder，bleedingti

5、me.7OtherchangesNausea（恶心），vomit（呕吐），anorexia（厌食），diarrhoea（腹泻），ascites（腹水）andgastricdilatation（胃扩张）.Infection（感染）.Hypoproteinemia（低蛋白血症），hyperglycemia（高血糖症）.8EvaluationandpreparationbeforeanesthesiaPreanestheticevaluationThisassessmentincludesapatienthistory,aphysicalexaminationandanyi

6、ndicatedlabtests,classifyingthepatientaccordingtotheASAphysicalstatusscalecompletestheassessment.9GeneralconditionPatientsareoftencombinedwithhypoproteinemia,anemia,coagulationdisorderandfluid,electrolyteandacid-basedisturbanceandsoon.ConcurrentdiseasesCardiovascular,pulmonary,cerebral,

7、hepaticandotherdiseasesarecommonlycoexisted.Statusofimmunosuppression（免疫抑制）andinfection（感染）.10PreanestheticpreparationCareofdonorkidneyKidneyshouldhavegoodcirculationperfusionbeforebeingseparatedfromdonor,warmischemiatimeandcoldischemiatimeshouldbeminimized,separatedkidneyshoul