100.12.22-术後出血.ppt

術後出血 R2 楊智裕 VS 張簡志炫 術前評估 術前評估 PT-- factors V, VII and X, prothrombin, and fibrinogen. aPTT-- intrinsic pathway (factors VIII, IX, XI, and XII). Platelet function -- platelet count and the bleeding time. 術前評估 Drug to hold Aspirin 10 to 14 day Clopidogrel 5 to 7 days Warfarin 4 days; INR 1.5 Warfarin use Heparin use when INR 2.0; stop 6 hr before surgery Start heparin 12hr postoperation 術前處置 血友病A (缺factor VIII) 輸factor VIII (1unit / mL血漿) vWD DDAPV-release of vWf and factor VIII Cryoprecipitate 術前處置 FFP all the coagulation factors Cryoprecipitate factor VIII, vWf, fibrinogen, fibronectin, and factor XIII 術前處置 血小板數量 Major procedure: 10萬 Minor procedure: 5萬 血小板功能異常: 腎衰竭or藥物 洗腎 DDAVP (vWf) platelet transfusions 術中出血 手術因素 凝血因素 血小板及凝血因子稀釋 低溫及酸血症: 血小板及凝血因子功能異常 bleeding, hypothermia, acidosis, and further bleeding 惡性循環 術中出血 瀰漫性凝血反應 (DIC) diffuse microvascular bleeding Due to bacteremia thrombocytopenia, decreased fibrinogen levels, and an increase in fibrin-split products Antibiotic; Platelets and coagulation factors 異常術後出血 評估 症狀 (意識改變) 手術紀錄 -- 出血量 Heart rate (15-30% blood loss) Blood pressure (30-40% blood loss) BT Wound Chest – hemothorax Abdomen – distention; echymosis Drain CBC; coagulation study 異常術後出血 手術(技術)因素 鮮紅出血 coagulation platelet正常 手術方法止血 凝血因素 Transfusion Correct hypothermia 兩者經常並存 異常術後出血 Shock Heart rate (15-30% blood loss) Blood pressure (30-40% blood loss) Fluid Transfusion Vasopressor: contraindicated 異常術後出血 報告完畢謝謝聆聽