器 官 移 植 麻 醉双语.pptVIP

* Thank you! * * * * 湘雅医院麻醉科 张海萍 * Anesthesia for Kidney Transplantation Kidneys are the most common major organ transplanted，the success of kidney transplantation，which is largely due to advances in immunosuppressive therapy ，has greatly improved the quality of life for patients with end-stage renal disease. * Indications Patients with end-stage renal diseases and dependent on dialysis（透析） for a long time. * Characteristic of Pathophysiology Changes of electrolyte and acid-base balance Water intoxication（水中毒），hyperkalemia（高钾）， hyponatremia（低钠），hypernatremia（高钠）and metabolic acidemia（代酸）. * Cardiovascular Hypertension（高血压） Renal ischemia，sodium retention and abnormalities in the renin-agiotension system result in systemic hypertension. Uremic cardiac disease myocardiosis （心肌炎），pericarditis（心包炎） ， left ventricular hypertrophy）（左室肥大），coronary ischemia（冠脉缺血）， angiosclerosis （血管硬化）. * Potential congestive heart failure（潜在性充血性心力衰竭） and pulmonary edema（肺水肿） arrhythmia（心律失常） * Hematologic Bone marrow suppression , decreased erythropoietin production , decreased erythrocyte production, increased deformation erythrocyte production and increased bleeding tendency Anemia ( 贫血). Liver disease coagulation factor ，Uremia(尿毒症) and using of heparin coagulation disorder， bleeding time . * Other changes Nausea（恶心） ，vomit（呕吐） ，anorexia（厌食） ， diarrhoea（腹泻） ，ascites（腹水） and gastric dilatation（胃扩张）. Infection （感染）. Hypoproteinemia（低蛋白血症），hyperglycemia（高血糖症）. * Evaluation and preparation before anesthesia Preanesthetic evaluation This assessment includes a patient history,a physical examination and any indicated lab tests , classifying the patient according to the ASA physical status scale completes the assessment. * General condition Patients are often combined with hypoproteinemia ,