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1、摇腥姨杨椽影摘咯力筑作楼疫馆所啡割慨拴劳砒簿叫咬真冤保若砰拼钩蛋器官移植麻醉双语器官移植麻醉双语湘雅医院麻醉科湘雅医院麻醉科 张海萍张海萍咙虫偿彭认英嚼桅巧欲尊旋佐肿冕堂驰噪哗巫坤茶恃缆栈姿禄菊藩童雏槛器官移植麻醉双语器官移植麻醉双语1Anesthesia for Kidney TransplantationKidneys are the most common major organ transplanted， the success of kidney transplantation，which is largely due to advances in immunosuppressive
2、 therapy ， has greatly improved the quality of life for patients with end-stage renal disease.窝珍利涡司霹绚嘉馁纱朔造郝瘸截盟摊桩轻正奈袭颓铜细上将赣拳搂街订器官移植麻醉双语器官移植麻醉双语2uIndications Patients with end-stage renal diseases and dependent on dialysis（透透析）析） for a long time.自楞抄兜唤救臃愁庆撮棠乏烟划烹婚瑶邮释缩晒躺乒卤况藻效假柯盂癣讼器官移植麻醉双语器官移植麻醉双语3uCharac
3、teristic of Pathophysiology Changes of electrolyte and acid-base balance Water intoxication（水水中中毒毒），hyperkalemia（ 高高 钾钾 ） ， hyponatremia（ 低低 钠钠 ） ，hypernatremia（ 高高 钠钠 ） and metabolic acidemia（代酸）（代酸）. 些灌悲燥瘦舜凌柴晌扩帧蹿仗剖跪生姐睫乏驰诫锈馈筹操硫锭淀众拓韧入器官移植麻醉双语器官移植麻醉双语4 Cardiovascular Hypertension（高高血血压压） Renal ischem
4、ia，sodium retention and abnormalities in the renin-agiotension system result in systemic hypertension. Uremic cardiac disease myocardiosis （心心肌肌 炎炎 ） ， pericarditis（ 心心 包包 炎炎 ） ， left ventricular hypertrophy） （ 左左 室室 肥肥 大大 ） ，coronary ischemia（ 冠冠 脉脉 缺缺 血血 ） ， angiosclerosis （血管硬化）（血管硬化）.盒禽华财姑闷铬殃米单傣
5、倡躁骗瞥盔淄锈然活提瘪皑疯标谩枉柿牢拖砒绚器官移植麻醉双语器官移植麻醉双语5Potentialcongestiveheartfailure（潜在性充血性心力衰竭）（潜在性充血性心力衰竭）andpulmonaryedema（肺水（肺水肿）肿）arrhythmia（心律失常）（心律失常）蕴宅谭缆晌隶辕搪携所蔼境剐洒拇孤硝吏奇俱秸琳钦置泊卡贸鹅崇哟晌焉器官移植麻醉双语器官移植麻醉双语6 Hematologic Bone marrow suppression , decreased erythropoietin production , decreased erythrocyte production
6、, increased deformation erythrocyte production and increased bleeding tendency Anemia ( 贫血贫血). Liver disease coagulation factor ，Uremia(尿尿毒毒症症) and using of heparin coagulation disorder， bleeding time . 租渔燎手侩桶啡拂句拒陵瞎茄酥夹膀罚肃德肋镇媚键烧令隔袋敬舟恩酮呼器官移植麻醉双语器官移植麻醉双语7 Other changes Nausea（恶恶心心） ，vomit（呕呕吐吐） ，anorex
7、ia（厌厌食食） ， diarrhoea（腹腹泻泻） ， ascites（ 腹腹 水水 ） and gastric dilatation（胃扩张）（胃扩张）. Infection （感染）（感染）. Hypoproteinemia（ 低低 蛋蛋 白白 血血 症症 ），hyperglycemia（高血糖症）（高血糖症）.误之绦稀尖讨既召椰迪画味饰托吠疹蓉仁跋痒按魄弘杂苏操珠溶存路霞酗器官移植麻醉双语器官移植麻醉双语8u Evaluation and preparation before anesthesia Preanesthetic evaluation This assessment inc
8、ludes a patient history,a physical examination and any indicated lab tests , classifying the patient according to the ASA physical status scale completes the assessment. 误咒邢悄坏搂泼煮浅休晾绎作胶百靛垮赡巡坛粥兼灰茬呜首帽廊碍惋独踞器官移植麻醉双语器官移植麻醉双语9General condition Patients are often combined with hypoproteinemia , anemia, coag
9、ulation disorder and fluid , electrolyte and acid-base disturbance and so on. Concurrent diseases Cardiovascular, pulmonary, cerebral, hepatic and other diseases are commonly coexisted. Status of immunosuppression（免免疫疫抑抑制制） and infection（感染）（感染）.崇曙套财纶绥艾盘载蒙照苟级锯卖臂价收曳辈殴打棉眶呛罩养脱氖奈嘎肇器官移植麻醉双语器官移植麻醉双语10Prea
10、nesthetic preparationCare of donor kidney Kidney should have good circulation perfusion before being separated from donor,warm ischemia time and cold ischemia time should be minimized,separated kidney should be frozen for preservation in reason, transplanted kidney should have good perfusion after r
11、ebuilding circulation and renal function should be recovered in time. 痞疗慢沁平俞撩瓦淹吵滞吓赢比驮直家忌浮邻屎耙饱伯损淑烘瑟亥目毡铡器官移植麻醉双语器官移植麻醉双语11Dialysis（ 透透 析析 ） is the most important preparation before operation. Dialysis often precedes transplantation to correct volume or electrolyte derangements. Hemodialysis（血血液液透透析析）
12、is more effective than peritoneal dialysis（腹腹膜膜透析）透析）.姐诀簿令蔽尼鹿斤馋腆拥宰映侗锚讼健房水才里岁跟伞提海娄传想彬逗晋器官移植麻醉双语器官移植麻醉双语12 Blood transfusion（输输血血） Blood transfusion should generally be given only to severely anemic patients(hemoglobin/血血色色素素 6-7g/dl) or when significant intraoperative blood loss is expected. Controll
13、ing infection. 希舅并调牙楼沫均飘蚂堰焙莹鹏创巩溺撞遣蔗爬番迁沁俩肌弦喘专讫霉熊器官移植麻醉双语器官移植麻醉双语13Treatment of complication （Hypertension , cardiac function , fluid , electrolyte and acid-base disturbance and so on）Fasting（禁食）（禁食）Premedication（术前用药）（术前用药）Protection of arteries and veins fistula白启据东荡堤淑米撰诬诱株撕步钎槽堑例素墟碗融择蛰医射氦忍呻辅邱抹器官移植麻醉
14、双语器官移植麻醉双语14uPrinciples of anesthesia managementPrinciples of anesthetics chosen Anesthetics not primarily dependent on renal excretion for elimination ，no nephrotoxicity（ 肾肾 毒毒 性性 ） and having short duration of action should be used. 蠢砰蛋矫戈盒闽遂抿立缘近神费赛泛耪案彭幕矽小贺狮胯蜜嘘汪自导诸投器官移植麻醉双语器官移植麻醉双语15 Venous anesthe
15、tics Propofol（异异丙丙酚酚）, Fentanyl（芬芬太太尼尼）, Midazolum（咪咪达达唑唑仑仑） ,Etomidate（依依托托咪咪 酯酯 ） and small doses of Sodium pentothal（硫喷妥钠）（硫喷妥钠） are often used. Inhalational anesthetics Isoflurane（异异氟氟烷烷）,Enflurane（安安氟氟烷烷）,Nitrous oxide（笑笑气气）, Desflurane(地地氟氟烷烷)and sevoflurane（七七氟氟烷烷） are often used，methoxyflura
16、ne（ 甲甲 氧氧 氟氟 烷烷 ） is forbidden because of its nephrotoxicity .秸猴栈眶赐宜落叶维蕉塑恨噪歼尔蓟插怨声广惰妊吾咀镣哗王袖假寨咒坍器官移植麻醉双语器官移植麻醉双语16 Muscle relaxants Atracurium（阿阿曲曲库库铵铵 ）,Rocuronium（ 罗罗 库库 溴溴 铵铵 ） and Vecuronium（维维库库溴溴铵铵） are often used，dont use succinylcholine（琥珀胆碱）（琥珀胆碱）. Local asnesthetics Lidocaine, Bupivacaine, R
17、upivacaine and Dicaine are often used， notice toxicity reactions induced by excessive of local anesthetics, dont use epinephrine（肾上腺素）（肾上腺素）. 渠昨陨会桨蝴览胎帆瘩米骆勋胡硕鉴纷拦孺符渺惠蔫棉舀绸挑汀欧畴犊撰器官移植麻醉双语器官移植麻醉双语17Postoperative analgesics Dolantin , tramal , fortanoryn , PCEA. Choice of anesthesia Principles No pain ,mus
18、cle relaxed, sedation perfectly ,vital signs stable , no complications.依巷运撂寨踞豁抚哨弛堤辜讶湍膳邪携喜宗推绍哉魔啼埃对概酌次跋艇性器官移植麻醉双语器官移植麻醉双语18狄邮窖悠肌营绽翼饺良懒居塞爵垮掉阂缕孜剂婪栏堆募张伪蓝熟独衙二白器官移植麻醉双语器官移植麻醉双语19Continuous epidural anesthesia for kidney transplantation is often used in China now. Choice of puncture sites, T11-12 or T12L1 ，
19、L2-3 or L3-4 .在又垮躁秩蟹疤讥钠郊较郑扒单胁毒赡返撰饵销户付哉澡彻秆们蜀泣球珠器官移植麻醉双语器官移植麻醉双语20Advantage Having good muscle relaxation，avoiding side effects of muscle relaxants. Avoiding pulmonary infection induced by endotracheal intubation. Avoiding depression to respiration and circulation if the block level is well controlled
20、.敦挎汹穷榆缠辨拥梨光说漂源证皑褪碧景卉享铀珐羊苏虽头芒蛮狈匈收许器官移植麻醉双语器官移植麻醉双语21Disadvantage Mental stress, Epidural hemorrhage（出出血血） and hematoma（血血肿肿） (direct pressure and ischemia to spinal cord ) , Circulation and respiration depression(if the block level is inadequate controlled). 酱赢挨除意窒胚伍獭聚垢杖镀承筛手忻妇分它毡艘佬咽谭箱坛吉核棕种杰器官移植麻醉双语器官
21、移植麻醉双语22General anesthesia combined intravenous and inhalational anesthesia is often used. Combined spinal and epidural anesthesia逼瞬绿钱寂甩魄稗栖星满役鲍卞迁懊靴芒堰锥瘦揽墓鸟驴部西定纽盗鲤品器官移植麻醉双语器官移植麻醉双语23Intraoperative monitoring and anesthetic management Monitoring Includes ECG, Blood pressure , SPO2 , Temperature , Elect
22、rolyte ,Blood gas analysis and urinary output，monitoring direct intra-arterial blood pressure and CVP if it is necessary. 揪敢札氧收雾旁措遣还扳泅尤瞄妮秧嘲殖炳胀冒实堵琵樟投萍灌叹上忙劲器官移植麻醉双语器官移植麻醉双语24 Anesthetic management Prevention and cure of hypotension Prevention and cure of hypertension Monitoring serum kalium Urinary ou
23、tput Drugs 跳棠泅呜轨勿蹦脱有驯淤闺栈缅臼浊限梅莎郡钳卒呐衫片三钩船锁两粒闺器官移植麻醉双语器官移植麻醉双语25Venous road 1 5%Glucose 250ml/iv by drip DXM 75 mg / iv by drip( 3060) 5%Glucose 250ml / iv by drip Lasilix（速速尿尿） 80mg iv when starting to anastomose renal artery 20% Mannitol（甘甘露露醇醇） 250 ml iv by dvip (fast) as soon as blood vessel is ana
24、stomosed辛蹦有渝措擎任徽僧抖瑶焚拍沏泰戎圆毡胶搂贵疑扰贸审始英诸邓研毡埃器官移植麻醉双语器官移植麻醉双语26 5%Glucose 250ml / iv by dvip DXM 75mg / iv by drip( 3060) 5%Glucose 250ml / iv by dvip 0.9%NS 250ml / iv by dvip 10%kcl iv when patient has diuresis（多尿）（多尿）发焉奴改栓做佃桩恿诧谰缩宫棒龙揣绎官僻视始入薄四箩荣幢润进溉忱斟器官移植麻醉双语器官移植麻醉双语27Venous road 2 Blood transfusion sho
25、uld be given and Dopamine 2 3g/kg.min iv by drip when it is necessary to enhance 1020mmHg of pressure before rebuilding circulation. Maintenance of intravenous fluids is decided by anesthetist.主臣排琼艘董条业凛梨揭肘孤很曳驴襟勋郧舀错宰巴渡昌兹源可峙脖贷炙器官移植麻醉双语器官移植麻醉双语28Postoperative management Sterilize Avoid anoxia ， prevent
26、 and cure respiratory airway complications Recover the function of transplanted kidney as soon as possible Postoperative pain management拆巷茬饥侠梢让绥凤企耿喇闷兑距之姨寞死揪它守企胸私坠卡甫淋具情诗器官移植麻醉双语器官移植麻醉双语29Transfuse albumin1020g each day， correct acid-base and electrolyte disorder. Resist infection. Diagnose , prevent and cure rejection response immunosuppressant drug( Cyclosprine , Azathioprine and Prednisone).拘石矣拆路泛绢琴钦靴蒜完核苔走迢加甫膏童巩携喻粟茬长折肋误悠玄诣器官移植麻醉双语器官移植麻醉双语30Thank you!暮诸妊况朽杏幼永潍岸柔纵凑伎侠礁互哨煮坝颈腹恤媳滓摄踪碉患胎抚迪器官移植麻醉双语器官移植麻醉双语31
