术前准备及术后处理姚宏伟.ppt

术前准备及术后处理Perioperative Management;Purpose; Definition: Management before, during after a surgical operation;Key points;1. Pre-Operative Preparation; Aims To achieve the best status for surgeons and patients; Principle Individualized preparation management for different patients operations Examples Nodular goiter Gastric Carcinoma Acute duodenal perforation with diffuse peritonitis;术前准备内容：一般性准备;1. 营养不良，低白蛋白血症 2. 高血压 3. 非心外科手术合并心脏病者（心衰、心梗） 4. 呼吸道疾病 5. 肝功能异常（代偿期 VS 失代偿期） 6. 肾功能衰竭 7. 糖尿病;Classification of operations ;Assessment of physical status To assess the general condition and function of important organs To evaluate the tolerance capacity ASA APACHE Ⅱ Scoring System;ASA classification;APACHE Ⅱ Scoring System;男，72岁，因乙状结肠癌伴急性肠梗阻4天入院. 既往：1年前“急性心梗”病史 ;急诊手术？限期手术？ 心脏功能评估？ 术前肠道准备如何开展？ ;Case 2;Case 2; Case 3 患者，男，62岁，无痛性进行性黄疸2周，大便灰白，小便浓茶色，通过B超和CT检查，初步诊断为胰头癌，拟行手术治疗。试问：该病人特殊的术前准备有那些？;Case 3 1. Vitamin K4 ， 胆汁酸盐 2. 抗生素 3. 保肝药物 4.其他 ;Case 3;Case 3;Goldman’s criteria（Cardiac Risk Index Criteria, CRIS）;Respiratory dysfunction;Preoperative management of respiratory disease;Liver disorder;Liver disorder;Approach to the patient with liver disease;Surgery in the patient with liver disease. Mayo Clin Proc 74:593–599, 1999. ;Malnutrition;术前讨论以及病情总结;2. Post-Operative Management;General management Management of postoperative complaint Management of postoperative complications ;Post-operative Management;General management;Wound healing and suture removing;Surgical wound classification;Management of Drainage; 患者，女，70岁，因急性胆管炎行胆囊切除胆总管切开取石，T管引流术，术后第3天拔除胆囊床引流管，2周拔除T管，拔管后2小时出现右上腹痛，发热、黄疸，B超提示右上腹有积液。保守无效于拔管后第2天再行剖腹探查，T管撕裂窦道置管引流术，术后2周恢复出院。 问：1.胆囊床引流管和T管应如何处理？; Management of postoperative complaint and complications; Management of postoperative complaint; Case 5 患者，男，76岁，因急性阑尾炎并穿孔 急诊全麻下行阑尾切除，腹腔引流术。术后