肝病患者麻醉..docVIP

Preoperative Evaluation of the Liver Disease术前肝脏疾病的评估 Guoyanhua 2009.02.23 Clinical Assessment 临床评估 Clinical manifestations ： loss of appetite, easy fatigability, malaise, altered sleep patterns, or subtle changes in personality. 临床表现：食欲不振，容易疲劳，倦怠，睡眠模式改变， 轻度性格改变。 Clinical Assessment 临床评估 obvious signs：peripheral edema, overt ascites, or encephalopathy develops 体征：外周水肿、重度腹水、脑病 Biochemical Tests生化监测 1、Hepatocellular Injury 肝细胞损害 1）Aminotransferases（氨基转移酶类） serum levels increase： aspartate aminotransferase (AST) 谷草转氨酶 alanine aminotransferase (ALT) 谷丙转氨酶 Biochemical Tests生化监测 1、Hepatocellular Injury ALT is relatively specific to the liver, whereas considerable AST are present in extrahepatic tissues, including the heart, skeletal muscle，et.al. ALT是肝脏相对特异性的酶，而相当大量的AST存于肝外组织，包括心脏、骨骼肌等。 Biochemical Tests生化监测 1、Hepatocellular Injury 2） Lactate Dehydrogenase 乳酸脱氢酶 lactate dehydrogenase (LDH) may reflect acute or chronic liver injury LDH可反应急性或是慢性肝损害 Biochemical Tests生化监测 1、Hepatocellular Injury 3）Glutathione S-Transferase 谷胱甘肽S -转移酶 relatively sensitive and specific test for detecting drug-induced hepatocellular damage GST是一个比较敏感、特异性检测药物诱导肝细胞的损害的指标。 Biochemical Tests生化监测 2、Hepatic Synthetic Capacity 肝合成能力 1）Serum Albumin 血清白蛋白 Serum albumin can provide useful information about hepatocellular function in certain clinical settings. 在某些临床情况中，血清白蛋白可用于提示肝细胞功能。 Biochemical Tests生化监测 2、Hepatic Synthetic Capacity 肝合成能力 2）Prothrombin Time 凝血酶原时间 the PT, or international normalized ratio (INR), can be useful for detecting rapidly declining liver function. PT或INR 可用于检测急性肝功能减退。 Biochemical Tests生化监测 3、Cholestatic Disorders 胆汁淤积 1）Alkaline Phosphatase 碱性磷酸酶 AP is a useful screening test for diseases of the liver or biliary tree, including acute hepatitis, malignancies, and cholestatic disorders. AP可用于筛查肝脏、胆道系统，包括急性肝炎、恶性肿瘤、胆汁淤积 Biochemical Tests生化监测 Cholestatic Disorders 胆汁淤积 2）Serum Bilirubin 血清胆红素 Serum bilirubin is the most use