器官移植麻醉双语.ppt

**湘雅医院麻醉科张海萍AnesthesiaforKidneyTransplantationKidneysarethemostcommonmajororgantransplanted，thesuccessofkidneytransplantation，whichislargelyduetoadvancesinimmunosuppressivetherapy，hasgreatlyimprovedthequalityoflifeforpatientswithend-stagerenaldisease.IndicationsPatientswithend-stagerenaldiseasesanddependentondialysis（透析）foralongtime.Characteristicof

PathophysiologyChangesofelectrolyteandacid-basebalanceWaterintoxication（水中毒），hyperkalemia（高钾），hyponatremia（低钠），hypernatremia（高钠）andmetabolicacidemia（代酸）.CardiovascularHypertension（高血压）Renalischemia，sodiumretentionandabnormalitiesintherenin-agiotensionsystemresultinsystemichypertension.Uremiccardiacdiseasemyocardiosis（心肌炎），pericarditis（心包炎），leftventricularhypertrophy）（左室肥大），coronaryischemia（冠脉缺血），angiosclerosis（血管硬化）.Potentialcongestiveheartfailure（潜在性充血性心力衰竭）andpulmonaryedema（肺水肿）arrhythmia（心律失常）Hematologic1Bonemarrowsuppression,decreasederythropoietinproduction,decreasederythrocyteproduction,increaseddeformationerythrocyteproductionandincreasedbleedingtendencyAnemia(贫血).2Liverdiseasecoagulationfactor，Uremia(尿毒症)andusingofheparincoagulationdisorder，bleedingtime.3Otherchanges01Nausea（恶心），vomit（呕吐），anorexia（厌食），diarrhoea（腹泻），ascites（腹水）andgastricdilatation（胃扩张）.02Infection（感染）.03Hypoproteinemia（低蛋白血症），hyperglycemia（高血糖症）.04EvaluationandpreparationbeforeanesthesiaPreanestheticevaluationThisassessmentincludesapatienthistory,aphysicalexaminationandanyindicatedlabtests,classifyingthepatientaccordingtotheASAphysicalstatusscalecompletestheassessment.*GeneralconditionPatientsareoftencombinedwithhypoproteinemia,anemia,coagulationdisorderandfluid,electrolyteandacid-basedisturbanceandsoon.ConcurrentdiseasesCardiovascular,pulmonary,cer