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1、PreoperativeandPostoperativeCareLisongTengMD,PhDTheDepartmentofOncologicalSurgery1stAffiliatedHospitalofZJUMC2021/9/18PreoperativeCareJudgingpreciselywhichpatientwillsurvive,orsuccumbto,anyspecificoperationforadisease,ordiseases,isimpossible.Themanyobviousv
2、ariablessuchasage,seriousnessoftheprimarydisease,andcoexistingdiseases,accountfortheintangiblenatureofriskinanyoperation.2021/9/18Whenaskedtoguaranteeanoperation,theexperiencedsurgeonrefusestoguaranteeanythingbuthisprofessionalconcernandcompetence.Estimatio
3、nofsurgicalriskisatbestaneducatedguessbasedonexperience.2021/9/18AssessmentofSurgicalRiskSurgicalriskinvolvesthreemainelements:ThePatientTheDiseaseTheTreatment2021/9/18ThePatientAgeHeartLungsKidneyLiverBloodEndocrinesystemPreoperativeTreatmentofDiabetesDehy
4、drationStatesNutritionalStatus2021/9/18AgeInfantprematurityandextremeoldageareassociatedwithincreasedoperativerisk.Withoperationsofgreatermagnitude,involvingincreasedphysiologicalstress,themortalityissubstantiallygreaterinolderpatients.2021/9/18Heart“Amanis
5、asoldashisarteries,”“especiallyhiscoronaryandcerebralarteries.”Whenlife-threateningdiseasearisesinapatientwithseriouscardiacdisease,evenafewhoursofintensivecardiaccare—tocontrolhypertension,arrhythmias,orheartfailure—canincreasesurvival.2021/9/18LungsPulmon
6、arydisfunctions—inabilitytomoveairinandoutofthelungs,toclearthebronchialtreebycoughing,andtoperfusethelungs—oftenunderliepostoperativepulmonarycomplications.Heavycigarettesmoking—majorcause2021/9/18Howmanyflightsofstairscanthepatientclimb?Howmanyblockscanhe
7、walkwithoutdyspnea?Canhecomfortablycarryoutroutinetasks?IfNormalexertionpromptsshortnessofbreath:PulmonaryVentilationTestsArterialBloodGases2021/9/18KidneysChronicrenalfailureincreasesoperativerisk.Urinecreatinineconcentrationsshouldexceedby10-foldthenormal
8、serumlevels.2021/9/18LiverJaundiceandascitesusuallyindicatesevereliverdisease.Anegativehistoryforjaundiceandnormalserumbilirubin,proteins,alkalinephosphatase,transaminases,andprothrombintimeusuallyindi
