课件：老年心脏病人非心脏手术麻醉.ppt

（4）支持心脏功能 ①调整前负荷：根据CVP和PCWP补充血容量或应用利尿剂；②降低后负荷：合理和正确应用扩血管药，如硝普钠等。减轻心脏负荷，增加心排；③增强心肌收缩力：应用多巴胺和米力农，后者对β 受体下调及舒张型心衰更有效；④改善心肌缺血和心肌顺应性，应用硝酸甘油或异舒吉，可扩张冠脉，减轻心肌缺血，尤其是后者对心率和血压影响较轻，一般静脉持续输注2～7mg/h，用量20～30mg。 六、术后处理 ①加强气道管理，必要时呼吸支持，防治低氧血症和呼吸衰竭。②维持血流动力学稳定，加强监护，及时处理，合理应用药物。③维持氧供需平衡，防治心肌缺血。④补足血容量，避免脱水或液量过多，维持水、电解质平衡。⑤维持体温正常，避免低温和寒战。⑥合理术后镇痛，确保病人无痛，但应注意避免镇痛、镇静药过量。 谢 谢！ 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 * When you see a preop patient, the very first question you ask yourself is: is this an emergent surgery for life-threatening pathology? If it is, then proceed the surgery and postoperative risk stratification and management may be appropirate. On the other hand, if the surgery is not a urgent one, we should proceed to step2 evaluation. * The nest question we ask is whether the patient had a coronary revascularization within past 5 years and more importantly, whether patient is symptom free. If answer is yes, then proceed the surgery. Step 3, to ask question if patient had a recent coronary evaluations, and if answer is yes without active ischemia, we shoulad also proceed the surgery without further study. If patient doesn’t have neither of them, then we proceed to step 4 and 5. * Step 4: if a patient has major clinical predictors and woithout any coronary workup or treatment, his surgery should be delayed for further cardiac workup. For patients with intermediate or minor clinical predictors, go to step 6 or 7. * Now we continue on the algorithm, step 6 for patients with intermediate clinical predictors by assessing their functional capacity: If their functional capacity is poor, or moderate functional capacity but will undergo a high risk surgery, their cardiac function should be assessed before going into OR. * Those patients who have minor or no clinical predictors, poor functional capacity and undergoing high risk procedure should have cardiac work before surgery. * To summerize, when we perform preop cardiac evaluation of a patient. We consider