内分泌病人的麻醉.pptVIP

references 1. 刘俊杰 赵俊主编 现代麻醉学 第二版 北京 人民卫生出版社 1997 2. Miller RD Anesthesia fifth edition 3. 国外医学·麻醉与复苏分册 有关文章 Chapter 24 Anesthesia for Endocrine Disease Cheng Zhigang associate Professor Department of Anesthesiology Xiangya hospital Central South University Main teaching points To review the effects of endocrine hormone Clinical pathophysiology of the endocrine diseases Main anesthesia points Diagnosis and treatment for Endocrine crisis ANESTHESIA FOR HYPERTHYROIDISM甲状腺功能亢进症手术的麻醉 1.1 PHYSIOLOGY OF THYROID HORMONES EFFECTS ON METABOLISM Thermogenic action Glycometabolism Lipid metabolism Protein metabolism EFFECTS ON GROWTH Main effects on brain and long bone Main effect time is within 4 months after birth EFFECTS ON NERVOUS SYSTEM Central nervous system excitation in adult EFFECTS ON CARDIOVASCULAR SYSTEM HR↑ CO↑ Cardiac work ↑ Myocardium contractility ↑ 1.2 CLINICAL SITUATION OF HYPERTHYROIDISM  1.2 CLINICAL SITUATION OF HYPERTHYROIDISM  ---symptom and physical sign Thyromegaly Temperament restless;Excitation; Sleeplessness; Two hand jitter Fear heat; Sweating Food appetite↑, body weight↓ Palpitation; HR↑; Pulse pressure↑ 1.2 CLINICAL SITUATION OF HYPERTHYROIDISM ---main laboratory examinations ⑴basal 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 1.3 Main anesthesia points 1.3 Main anesthesia points Preparation for anesthesia safe Assurance from Sufficient preparation 1.3 Main anesthesia points ·Preparation for anesthesia s