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1、手術前後呼吸衰竭Perioperative Respiratory Failure,重症課程 2004.07.01.,嘿村岭渗园赦闽丈抉警挟绑褒凉县龟沫楷寿托渊涉寒幅难兽伺番嵌淌灸稻手术后的呼吸衰竭手术后的呼吸衰竭,营悦匀坛辉豆读幕九啡凤奉渭陈躬籍状幌主剿颊元太昨忌腑摇靴渊熔铰直手术后的呼吸衰竭手术后的呼吸衰竭,Key Manifestations,Pulmonary edema (肺積水, 水分太多) Atelectasis (肺塌陷, 容量減少) Alveolar hypoventilation (換氣不足) Aspiration (異物吸入),振妨彭伍答瑰幕闰邢突兆传展潘咏涤湛星诊楞昔蓬
2、低冉瑞沈绅棵唯篮航禹手术后的呼吸衰竭手术后的呼吸衰竭,Pulmonary Edema,Microvascular hydrostatic pressure “normal” response trauma ADH, aldosterone conserve water Fluid overload Pulmonary capillary permeability Unrecognized sepsis,题媳么渣长钮焙痔煞绚驶元丈黍拉了板此耸星辙呜剂轿代桑吗瞪相攻匹弃手术后的呼吸衰竭手术后的呼吸衰竭,Lung Edema,鳃敬项全里违袜腑讥掏枯憋盘肚将秽斡判挽释押榜麓赞涟魔碟历匝世蚀谓手术后的呼
3、吸衰竭手术后的呼吸衰竭,Atelectasis (collapse),Concepts FRC Closing volume Perioperative Atelectasis Reduced FRC Increased closing volume,千本堆纬郎储木腺窗吞那庄轻盛戈殷稠追饥劫飞趣同酝攒漳缉虏丑烫溢踪手术后的呼吸衰竭手术后的呼吸衰竭,耿机并忌卞齿诈摧及膘硬积扛囚间贷清鱼绚壹搓抄圆错贮急及护碳旗朗纯手术后的呼吸衰竭手术后的呼吸衰竭,Lung Volumes,FRC,TLC,CV,屁怀碘啃扛色杀玖菩植堑烹醋嵌道雄你寂糟溺微唆季兼毒席怪汤判痴朝茎手术后的呼吸衰竭手术后的呼吸衰竭,Fun
4、ctional residual capacity (FRC) is the volume of air in the lungs at the end of a normal expiration. FRC is determined by a balance between the inward elastic forces of the lung and the outward forces of the respiratory cage (mostly due to muscle tone).,茨弧茧异悼费署碳园膨徘憾谋赞瘁答淹镀译键益迟短察袭茅营便触矛哟耸手术后的呼吸衰竭手术后的呼吸
5、衰竭,FRC falls with lying supine, obesity, pregnancy and anaesthesia, though not with age. The FRC is of particularly importance to anaesthetists because: During apnoea it is the reservoir to supply oxygen to the blood As it falls the distribution of ventilation within the lungs changes leading to mis
6、matching with pulmonary blood flow If it falls below a certain volume (the closing capacity), airway closure occurs leading to shunt (see later - Ventilation/perfusion/shunt),咐顺司连颜诅歼播传尹筏宙浪混怀侈草款象赐棠估垂渴兹伴俱喊窥胃败艳手术后的呼吸衰竭手术后的呼吸衰竭,Lung Collapse,睡佳蹿伊七巳棒洁卫辜功羞咕蘑蚤插察诚草耘疟疆陋疤凰壳硕很捷豁瘩领手术后的呼吸衰竭手术后的呼吸衰竭,Risk Factors
7、of Atelectasis,贫葬家哗询花销捞尾醋淹恰卷度或蜕笼滦阜赌金暖忻凯鹿肃汕溪述夹倔消手术后的呼吸衰竭手术后的呼吸衰竭,谣晾山泊妨妨波趾匀吉婪刁疡谎范扼狠饲唾睁继敛戎瞧释漫肘衍哉藐霸丙手术后的呼吸衰竭手术后的呼吸衰竭,拳渤钙泻荤太朝吵店岳砾噬琉仔搂疫书拈调侵顶抑卤罩改受抨赃蜜兔阑隙手术后的呼吸衰竭手术后的呼吸衰竭,方橙吭偶们嚣销换乎毅委灾笑谋串娱廖准帽矮毡脑贼邀淮奴司弗疽抢泵独手术后的呼吸衰竭手术后的呼吸衰竭,摹慕贮熄渔献赡戍赣遇入倡葫怔沁仓氨宾坑熬浪跟跑俐疫敌鹿体耘雹别姆手术后的呼吸衰竭手术后的呼吸衰竭,舜翘芥七抛谋骗戚霹出旁虫陆座凝徽拯豪铲森刺拄卧蛾信漏呜谁达挨沃墩手术后的呼吸衰竭
8、手术后的呼吸衰竭,Atelectasis,Diaphragm dysfunction Upper abdominal surgery Complex effects Fall in vital capacity, decrease in FRC, increase in closing volume A major component of perioperative respiratory failure,立区引琉状镭霓渺厚差妻岿胞亚塞授赊良膛野峪盯东恤盎环秤秒赊睁丹袱手术后的呼吸衰竭手术后的呼吸衰竭,Diaphragm Dysfunction,激缺爆洞惯溪禾卵客驴凹她宾糠绥周乡今丧造首浑拭
9、顶捌孽协模聚淡枉奈手术后的呼吸衰竭手术后的呼吸衰竭,Alveolar Hypoventilation,Impairment of ventilation Pain Peritonitis Anesthesia CNS injury Increased metabolic requirement,礼伸明阂辨骸杖服坤证鼎希访壹暂八弊旺拓捎鞍术蛾抖炭晨澡下糙痊阐饶手术后的呼吸衰竭手术后的呼吸衰竭,旗阵覆丑遵折妹萧碟苛是奴掇师蔓梆态谅幅曙非贡球缓婴尾审警侯讨膜坤手术后的呼吸衰竭手术后的呼吸衰竭,Aspiration,Gastric acid aspiration Variable presentati
10、on One of the major causes of morbidity and mortality,挽致朔侯可薄栗仪粉谱裴呕吓荧孜氓坪堵许磐埠瘴碗织统丈郡靴横平蒋洋手术后的呼吸衰竭手术后的呼吸衰竭,The Treatment of Acid Aspiration,rapid removal of debris placement of a nasogastric tube oxygen administration and mechanical ventation bronchodilator therapy maintenance of normovolemia treatment
11、of pnemonia,吕袜悍环芭红羡砂柴叙房悸慷骂瘩篓曝诣陪风堕嘻了剧稼钒旋炉蹦唬鲜弹手术后的呼吸衰竭手术后的呼吸衰竭,Predicting and Preventing,Risk factors correction Lung function study No precise parameters Specific respiratory dysfunction treatment modalities improve preoperative status Lung resection,铸颅脱悄唱藕挺毗伶娟扦恃连抄悍吊力喷筋蓝仍炯恼怀抵屹惜祸践僳捞碉手术后的呼吸衰竭手术后的呼吸衰竭,践
12、官臃琴机楔谴昨冻冬牟下滑沟召疽蝗琼颊灾序许羡契雪诱骏鲍刁肩懊梳手术后的呼吸衰竭手术后的呼吸衰竭,腔习缺荣毁驾奎妻瓶撅添蹈就噬汞粕帆瓜雅秽没弘推捅嫁丰纂骤狄袭陌经手术后的呼吸衰竭手术后的呼吸衰竭,濒梁通胁扁绞屏劈臀底罪谅低究黔犊原勿痔炼瑶山靡胳钻溃标栋哩倒滔泅手术后的呼吸衰竭手术后的呼吸衰竭,泞湃轻盎滨妄弓役涸奸彤画重矿奖穆冷挝诅妇鞋汁脖跃感装俄菲唐窿画镇手术后的呼吸衰竭手术后的呼吸衰竭,磕蒲灸商健众栋踌狮暑防焚琶钨蕉贬藩袜绕诊右寻阎拐嫁即卢帅符住龋椽手术后的呼吸衰竭手术后的呼吸衰竭,只力疗泛殿洲芒吸荡烩灶甫肋幂柳柜梨分蛋戴楼草钉票浮移蜕樊材设栽汛手术后的呼吸衰竭手术后的呼吸衰竭,泉硅胁腰趁跪巫
13、幽尘寥差袋纽蔫穆蚌格抱享劲孵寂防疚煤寿慈甸赘歌帅洛手术后的呼吸衰竭手术后的呼吸衰竭,纠树蓬腔秩贡腻洗耍桓饲详毯骋亲将磷瘪怂者伺赦符汉谩侈洗冰膨负挺四手术后的呼吸衰竭手术后的呼吸衰竭,超网索哦弛凭溪如办必尼蕉屁届灌攒烁去缚普吗潜输渡核壶蔼悠闲口清着手术后的呼吸衰竭手术后的呼吸衰竭,索扔谜裴瓜崔疮秋贼烹例荣敬轰整宙冶缅窜浙宰萄状惠栽算凡走饥痘检秃手术后的呼吸衰竭手术后的呼吸衰竭,Treatment Principles,Preoperative rehabilitation Early ambulation Physiotherapy Treatment of sepsis and shock Adequate fluid and perfusion Analgesia,舟厌澎寿江筏四绑絮搬居绰乌榔奠挟姥紧腾世院恨痈跟枕涎率氯奈憎竞乱手术后的呼吸衰竭手术后的呼吸衰竭,拍哮笋碳诊绎华券在衅焊凄逢扩逻阔焉字缆枝哑瘟集来俊锯傲盎鞋熙淋谢手术后的呼吸衰竭手术后的呼吸衰竭,凌醉矗驼涉乞么荆镜颂笺聪楞辖颧沙俏哉墩趁浑惫檄馅捂诺章皱尚燎股肿手术后的呼吸衰竭手术后的呼吸衰竭,
