按一下以編輯母片,第二層,第三層,第四層,第五層,按一下以編輯母片標題樣式,*,手術前後呼吸衰竭Perioperative Respiratory Failure,重症課程,2004.07.01.,Key Manifestations,Pulmonary edema(肺積水,水分太多),Atelectasis(肺塌陷,容量減少),Alveolar hypoventilation(換氣缺乏),Aspiration(異物吸入),Pulmonary Edema,Microvascular hydrostatic pressure,“normal response trauma ADH,aldosterone conserve water,Fluid overload,Pulmonary capillary permeability,Unrecognized sepsis,Lung Edema,Atelectasis(collapse),Concepts,FRC,Closing volume,Perioperative Atelectasis,Reduced FRC,Increased closing volume,Lung Volumes,IRV,ERV,RV,TV,FRC,TLC,CV,Functional 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).,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 mismatching 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),Lung Collapse,Risk Factors of Atelectasis,Promoting,Preventing,Reduced FRC,Supine,Upright,Obesity,Alternating postures,Ascites,PEEP,Peritonitis,Sighs,Upper abdominal incision,Analgesia,Increased closing volume,Age,Preop physiotherapy,Smoking,Cessation,Bronchospasm,Bronchodilation,Airway secretion,Cough,suction,Pulmonary edema,Avoid over hydration,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,Diaphragm Dysfunction,Alveolar Hypoventilation,Impairment of ventilation,Pain,Peritonitis,Anesthesia,CNS injury,Increased metabolic requirement,Aspiration,Gastric acid aspiration,Variable presentation,One of the major causes of morbidity and mortality,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 of,pnemonia,Predicting and Preventing,Risk factors,correction,Lung function study,No precise parameters,Specific respiratory dysfunction,treatment modalities improve preoperative status,Lung resection,Treatment Principles,Preoperative rehabilitation,Early ambulation,Physiotherapy,Treatment of sepsis and shock,Adequate fluid and perfusion,Analgesia,