内分泌病人的麻醉(07年).pptVIP

Chapter 26 Anesthesia for Patients with Endocrine Disease references 1. 刘俊杰 赵俊主编 现代麻醉学 第三版 北京 人民卫生出版社 2. Miller RD Anesthesia fifth edition 3. 国际麻醉与复苏杂志 有关文章 4. Morgan GE et al Clinical Anesthesiology third edition Chapter 26内分泌病人手术的麻醉 Anesthesia for Patients with Endocrine Disease Cheng Zhigang 程智刚 Department of Anesthesiology Xiangya Hospital 1. ANESTHESIA FOR PATIENTSWITH HYPERTHYROIDISM甲状腺功能亢进症手术的麻醉 1.1 PHYSIOLOGY OF THYROID  甲状腺激素的生理作用 EFFECTS ON METABOLISM 对代谢的影响 Thermogenic action Carbohydrate metabolism Lipid metabolism Protein metabolism EFFECTS ON GROWTH 对发育与生长的影响 Main effects on brain and long bone Main effect time is within 4 months after birth EFFECTS ON NERVOUS SYSTEM对神经系统的影响  Central nervous system excitation in adult EFFECTS ON CARDIOVASCULAR SYSTEM 对心血管系统的影响 HR↑ CO↑ Cardiac work ↑ Myocardium contractility ↑ 1.2 CLINICAL SITUATION OF HYPERTHYROIDISM 甲状腺功能亢进症的临床特征  流行病学 总患病率约为3. 0% ； 女性为4. 1% ,男性为1. 6% ; 各年龄均可发病,以20～40岁为多 城市多于农村。 绝大多数（99％）的甲亢患者都是Graves病、功能性多结节性甲状腺肿、功能性腺瘤中的一种发展而成,Graves病是最常见的病因 。 1.2 CLINICAL SITUATION OF HYPERTHYROIDISM  ---symptom and physical sign 甲状腺肿大； 性情急躁、容易激动、失眠，两手颤抖； 怕热，多汗； 食欲亢进，体重减轻； 心悸、脉快有力、脉压增大。 甲亢性心脏病 12%---22% 1.2 CLINICAL SITUATION OF HYPERTHYROIDISM ---main laboratory examinations ⑴基础代谢率测定 basal metabolic rate (BMR) normal : ±10% abnormality: +20-30% mild +30-60% moderate 60% Severity 1.2 CLINICAL SITUATION OF HYPERTHYROIDISM ---main laboratory examinations ⑵Serum T3 and T4 assay normal : every lab difference HYPERTHYROIDISM: T3 4 times normal value T4 2.5 times normal value TSH正常或降低 1.3 TREATMENT OF HYPERTHYROIDISM 甲状腺功能亢进症的治疗方法  1.3 TREATMENT OF HYPERTHYROIDISM 甲状腺功能亢进症的治疗方法  1.4 Main anesthesia points