围手术期处理讲义(英文版).ppt

20190109 医疗课件医生医院治疗疾病我人有的和主产不为这工要在地一上是中国经以发了民同 优秀幻灯片与大家分享 优秀幻灯片与大家分享 PREOPERATIVE EVALUATION AND PREPARATION To assess the patient`s overall state of health To determine the risk of the impending surgical treatmentTo guide the preoperative preparation General Health Assessment a. Complete history Present,past and family Such an evaluation,seeks to identify abnormalities that may influence operative risk or may bear on the patient’s future well-being B. physical examination A rectal examination should always be done c. Laboratory test Urinalysis, blood count, and chest X-rays ECG and stool test for occult blood for  patients over 40 The adequacy of liver and kidney  function should be tested if impairment  is suspected Factors affecting operative risk Nonsurgical disorders frequently increase the risk of surgical procedures. Fatal complications are often related to preexisting organic disease, or to deficient immune and nutritional status. a.nutrition Malnutrition increases the operative death rate Weight loss more than 20% caused by illness (cancer,intestinal disease)  Causes of inadequate nutrition b.pulmonary dysfunction (hypoxia, atelectasis, pneumonia) Preoperative evaluation the degree  of respiratory impairment History of heavy smoking and cough, obesity, advanced age, upper abdominal surgery, know pulmonary disease  A chest X-ray,ECG, blood gases  CO2 retention usually indicateds severe  pulmonary dysfunction (PaCo2 50mmHg) need for an elective  operation, reevaluated  Preparation for respiratory system c.cardiovascular system Risk of operation in cardiac patient is increased  Symptoms: Contraindication: Preparation for cardiovascular system:  d.renal disease Screening of Bun, creatinine determination and urinalysisThe most common cause of oliguria on surgical services is hypovolemia rather than rena