《内分泌病人的麻醉 (2).ppt》由会员分享，可在线阅读，更多相关《内分泌病人的麻醉 (2).ppt（56页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、WELCOME TO WELCOME TO OUR DEPARTMENTOUR DEPARTMENT1references1.刘刘俊俊杰杰 赵赵俊俊主主编编 现现代代麻麻醉醉学学 第第二二版版 北京北京 人民卫生出版社人民卫生出版社 19972.Miller RD Anesthesia fifth edition3.国外医学国外医学麻醉与复苏分册麻醉与复苏分册 有关文章有关文章2 Chapter 24 Anesthesia for Endocrine DiseaseCheng Zhigang associate ProfessorDepartment of AnesthesiologyXian
2、gya hospitalCentral South University 3Main teaching pointsTo review the effects of endocrine hormoneClinical pathophysiology of the endocrine diseasesMain anesthesia pointsDiagnosis and treatment for Endocrine crisis41.ANESTHESIA FOR HYPERTHYROIDISM甲状腺功能亢进症手术的麻醉甲状腺功能亢进症手术的麻醉51.1 PHYSIOLOGY OF THYROI
3、D HORMONES6EFFECTS ON METABOLISMThermogenic actionGlycometabolismLipid metabolism Protein metabolism7EFFECTS ON GROWTHMain effects on brain and long boneMain effect time is within 4 months after birth8EFFECTS ON NERVOUS SYSTEM Central nervous system excitation in adultEFFECTS ON CARDIOVASCULAR SYSTE
4、M HR CO Cardiac work Myocardium contractility 91.2 CLINICAL SITUATION OF HYPERTHYROIDISM 101.2 CLINICAL SITUATION OF HYPERTHYROIDISM -symptom and physical signThyromegalyTemperament restless;Excitation;Sleeplessness;Two hand jitterFear heat;SweatingFood appetite,body weightPalpitation;HR;Pulse press
5、ure111.2 CLINICAL SITUATION OF HYPERTHYROIDISM -main laboratory examinationsbasal metabolic rate(BMR)normal:10%abnormality:+20-30%mild +30-60%moderate 60%Severity121.2 CLINICAL SITUATION OF HYPERTHYROIDISM -main laboratory examinations Serum T3 and T4 assay normal:every lab difference HYPERTHYROIDIS
6、M:T3 4 times normal value T4 2.5 times normal value131.3 Main anesthesia points141.3 Main anesthesia points Preparation for anesthesia safe Assurance from Sufficient preparation151.3 Main anesthesia points Preparation for anesthesia special determination before surgery Cervical fluoroscopy or photog
7、raphCheck heartLaryngoscope BMR161.3 Main anesthesia points Preparation for anesthesia Drugs therapy anti-thyroid drugs Propylthiouracil,MethylthiouracilTapazole,athyromazole171.3 Main anesthesia points Preparation for anesthesia Drugs therapy Lugols solution Propranolol181.3 Main anesthesia points
8、therapy for anesthesia Psyche PreparationRelief apprehensivenessSedative agent or soporific1.3 Main anesthesia points Preparation for anesthesia Diet191.3 Main anesthesia points Preparation for anesthesia surgery ConditionsBMR:20%HR:80bpmGeneral Symptoms are controlled and emotion Stable201.3 Main a
9、nesthesia points PremedicationSedative agent or MorphineScopolamine(hyoscine)Atropine 211.3 Main anesthesia points Anesthesia method local anesthesia cervical plexus blockgeneral anesthesia adaptation:221.4 Prevent and therapy accident and Complication during operation231.4 Prevent and therapy accid
10、ent and Complication during operation thyroid crisis Reason Clinical situation Therapeutics241.4 Prevent and therapy accident and Complication during operation respiratory tract obstruction Reason Clinical situation Therapeutics251.4 Prevent and therapy accident and Complication during operation ble
11、eding(hemorrhage)26 2.ANESTHESIA FORPHEOCHROMOCYTOMA ECTOMY嗜铬细胞瘤切除手术的麻醉 272.1 PATHOPHYSIOLOGY AND CLINICAL SITUATION282.1 PATHOPHYSIOLOGY AND CLINICAL SITUATION Catecholamine Noradrenaline ,Adrenaline cardiovascular system pathological changes Main symptom is hypertension 292.1 PATHOPHYSIOLOGY AND C
12、LINICAL SITUATION Main symptom Hypertension major Noradrenaline excretionMetabolism change major Adrenaline excretion302.2 Preparation for anesthesia Drugs therapy ,receptor Blocking Agent reduce blood vessel resistance,maintain circulation stable commonly used drugs Phenoxybenzamine(酚苄明):10mg bid o
13、r tid Prazosin(哌唑嗪):0.5-2mg tid Propranolol(心得安):10-20mg tid312.2 Preparation for anesthesia Drugs therapy supplementary Blood volume322.2 Preparation for anesthesia PremedicationMorphine 10mgScopolamine(东莨菪碱）东莨菪碱）Atropine 332.3 Anesthesia management Anesthesia method Continuous epidural anesthesiaG
14、eneral anesthesia342.3 Anesthesia management principle 352.3 Anesthesia management correlated changes therapy hypertension crisis Definition Appear time Prevention and therapy362.3 Anesthesia management correlated changes therapy hypotension Reason Prevention Therapy 372.3 Anesthesia management corr
15、elated changes therapy hypoglycemia Reason Therapy 382.3 Anesthesia management correlated changes therapy cardiac arrhythmia Reason Therapy 39 3.ANESTHESIA FOR HYPERCORTISOLISM 皮质醇增多症手术的麻醉处理皮质醇增多症手术的麻醉处理 403.1 CORTEX HORMONE BIOLOGY ROLE the role of corticosteroid the role of mineralocorticoid 413.2
16、 clinical characteristic of hypercortisolism 423.3 PREPARATION FOR ANESTHESIAgeneral preparation supply corticosteroid Hydrocortisone（氢化可的松）氢化可的松）100mg iv by drip premedication reduce the dose of the Sedatives 433.3 PREPARATION FOR ANESTHESIAgeneral preparation supply corticosteroid Hydrocortisone（氢
17、化可的松）氢化可的松）100mg iv by drip premedication reduce the dose of the Sedatives 443.4 Anesthesia management choice a anesthesia method General anesthesia epidural anesthesia453.4 Anesthesia management Respiration management Circulation management Other Attentiveness matters464.ANESTHESIA FOR DIABETES 糖尿病
18、病人的麻醉处理糖尿病病人的麻醉处理 474.1 Basal concept and clinical type of diabetes Definition Clinical characteristic Types of diabetes(WHO)IDDM NIDDM 484.2 Roles of the insulin 494.3 Pathophysiology of diabetes 50 4.4 Therapy of diabetes 51 4.5 Evaluate patients condition 52 4.6 Anesthesia management 53 4.6 Anesthesia management choice an anesthesia method54 4.6 Anesthesia management anesthesia processingMonitor glucose in blood and urineSupply glucose and insulin55 4.6 Anesthesia management ketone body acidosisReasonClinical diagnosis therapy56