文档介绍：1
Chapter 26 内分泌病人手术的麻醉 Anesthesia for Patients with Endocrine Disease
Cheng Zhigang 程智刚
Department of Anesthesiology
Xiangya Hospital
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1. ANESTHESIA FOR PATIENTS WITH HYPERTHYROIDISM 甲状腺功能亢进症手术的麻醉
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PHYSIOLOGY OF THYROID 甲状腺激素的生理作用
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EFFECTS ON METABOLISM 对代谢的影响
Thermogenic action
Carbohydrate metabolism
Lipid metabolism
Protein metabolism
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EFFECTS ON GROWTH 对发育与生长的影响
Main effects on brain and long bone
Main effect time is within 4 months after birth
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EFFECTS ON NERVOUS SYSTEM 对神经系统的影响 Central nervous system excitation in adult
EFFECTS ON CARDIOVASCULAR SYSTEM
对心血管系统的影响
HR↑
CO↑
Cardiac work ↑
Myocardium contractility ↑
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CLINICAL SITUATION OF HYPERTHYROIDISM 甲状腺功能亢进症的临床特征
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流行病学
总患病率约为3. 0% ;
女性为4. 1% ,男性为1. 6% ;
各年龄均可发病,以20~40岁为多
城市多于农村。
绝大多数(99%)的甲亢患者都是Graves病、功能性多结节性甲状腺肿、功能性腺瘤中的一种发展而成,Graves病是最常见的病因。
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CLINICAL SITUATION OF HYPERTHYROIDISM ---symptom and physical sign
甲状腺肿大;
性情急躁、容易激动、失眠,两手颤抖;
怕热,多汗;
食欲亢进,体重减轻;
心悸、脉快有力、脉压增大。
甲亢性心脏病 12%---22%
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CLINICAL SITUATION OF HYPERTHYROIDISM ---main laboratory examinations
⑴基础代谢率测定
basal metabolic rate (BMR)
normal : ±10%
abnormality:
+20-30% mild
+30-60% moderate
>60% Severity