手术前准备和手术后处理ppt课件

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Preoperative Evaluation
对病人健康情况进行 全面评价，明确是否存在增加 手术危险性或不利恢复的因素
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第一类病人： 耐受力良好，重要
器官无器质性病变，或功 能处于代偿状态，进行一 般准备后手术
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第二类病人：
耐受力不良，重要器官有 器质性病变，或功能处于失代偿 状态，外科疾病对全身造成明显 影响，需作特殊准备后手术
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Hepatic disease 急性肝炎或肝功能严重损害 的慢性肝病，一般不宜施行 手术 术前准备：增加肝糖原储备、 增强肝细胞功能、 改善凝血 状态、 纠正低蛋白血症、 消 退腹水
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Disease of Kidney
o Maintaining renal blood flow and glomerular filtration rate
Malnutrition
Morbidity and mortality increased
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Correcting disorder of fluids, electrolytes, acid base Supplying energy, albumin, vitamins, and correcting anemia Retaining positive balance of nitrogen metabolism
围手术期处理
Perioperative managements
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Surgical Procedure
Therapeutic Process Traumatic Process
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Aims
❖ 术前准备: 提高病人对手 术的耐受性
❖ 术后处理: 减少并发症， 促进康复
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Preoperative preparations
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❖ Gastrointestinal Tract：
术前12小时禁食；4小时禁饮
Special preparation for gastrointestinal
operation
liquid diet
intestinal bacteria antibiotics,
GI tube cleaning enemaSBiblioteka ecial examinations
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Operative Character
o Selective Operation：手术的迟早 不影响疗效，做好充分的术前准备
o Limited Operation：手术时间有一 定限度的选择，尽可能做到充分的 术前准备
o Emergency Operation：最短时间 内迅速手术，进行必要的术前准备
术前处理的几个阶段：
Clinical Diagnosis Preoperative Evaluation Preoperative Preparation
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To make sure the diagnosis
Illness history
Physical examination
Laboratory findings
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❖ The others: cleaning the skin of operative area temperature menstruation sedatives for good sleep cross-matching of blood urinary catheter
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Special preparation （针对二类病人）
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Preventive infection:
无菌原则、避免院内感染、预防性应用抗菌素
1) Infected operation 2) intestinal operations 3) large operation 4) contaminated trauma 5) cancer, blood vessel operations 6) organ transplantation
o Keeping fluids, electrolyte, and acid-base balance
o Using diuretic ( mannitol ) o Avoiding use of renal impairing
drugs o Using dialysis therapy for severe
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Preoperative Preparation
根据诊断、术前评价情 况和手术性质所采取的措施
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General Preparation ❖ Psychological ：医务人员、
病 人及家属
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❖ Physiological
适应术后变化的锻炼: 手术特殊体位的适应性训
练，术后床上活动、咳嗽、翻 身、排便等
renal dysfunction
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Hypoadrenocorticism
正在应用皮质激素治疗或在6
~12月内曾用皮质激素治疗超
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Hypertension:
Controlling blood pressure below 21.3/13 K Pa or 160/100mmHg, but not necessar to normal
Avoiding use of 1 receptor retarder (reserpine) two weeks before operation
Heart failure delayed 3-4 weeks to operation
Acute myocardial infarction delayed 6 months to operation
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Respiratory dysfunction 阻塞性肺换气功能不全，常见 有哮喘、肺气肿 术前准备：戒烟二周，深呼吸 锻炼、 应用支气管扩张剂、雾化 吸入、应用激素、应用抗生素
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Cardiopathy
Heart diseases with normal cardiac rhythm and without tendency of heart failure are well endured to operation
Acute myocarditis are poor tolerant to operation