心肺功能不全的物理治療診斷與治療：general surgery

1、General SurgeryCommon types of surgery常見手術(shù)類型Abdominal 腹部Head & Neck 頭&頸Vascular 血管Mastectomy 乳房切除術(shù)Cholecystectomy 膽囊切除術(shù)Hiatus hernia repair 疝氣修復(fù)appendectomy闌尾切除術(shù)Abdominal surgery: 腹部手術(shù)Abdominal Aortic Aneurysm repair (AAA) 腹部大動脈瘤修復(fù)Aortic aneurysm stenting 大動脈瘤支架Abdominal surgery: 腹部手術(shù)Pancreatic-duod

2、enectomy (Whipples) 胰腺切除術(shù)removal of pancreas, bile duct, partial removal of stomach, duodenum 胰腺，膽道，部分胃部、十二指腸切除cancer of the head of pancreas胰頭癌Abdominal surgery:腹部手術(shù)Cystectomy 膀胱切除術(shù)Colectomy 結(jié)腸切除術(shù)Abdomino-perineal resection 腹會陰切除術(shù)removal of colon / rectum結(jié)腸-直腸切除(the patient should be made aware of

3、the need to use a colostomy bag) 患者應(yīng)被告知將會運(yùn)用人工肛門袋Abdominal surgery:腹部手術(shù)Hysterectomy子宮切除術(shù)Werteheims hysterectomytotal abd. hysterectomy, bilateral salpingo oophorectomy, lymph nodes腹腔子宮切除術(shù)，雙邊輸卵管卵巢切除術(shù)，淋巴結(jié)Prostatectomy 前列腺切除術(shù)Trans-urethral resection of prostate (TURP)經(jīng)尿道前列腺切除術(shù)（經(jīng)尿道前列腺電切）Laparoscopic surg

4、ery 腹腔鏡手術(shù)Head & Neck surgery 頭頸部手術(shù)For cancer of the tongue, pharynx, larynx , thyroid carcinama舌、咽、喉癌、甲狀腺癌Radical neck dissection 根治性頸部淋巴清掃術(shù) removal of cancer, lymph nodes 腫瘤、淋巴結(jié)切除 tracheostomy care 氣管切開護(hù)理甲狀腺切除Vascular surgery 血管手術(shù)Embolectomy 栓子清除術(shù)Vascular surgery 血管手術(shù)Percutaneous transluminal angio

5、plasty經(jīng)皮腔內(nèi)血管成形術(shù)Mastectomy乳房切除術(shù)Common incision sites 常用切口位置什么樣的手術(shù)才是真正成功的手術(shù)？手術(shù)技術(shù)的成功是否是評價手術(shù)完全成功的唯一標(biāo)準(zhǔn)？LOREM IPSUM 1、the patients complete return to full participation in life and the capacity to perform its requisite activities2、avoidance of recurrence of the problem for which the individuals surgery wa

6、s indicated3、reduced subsequent doctor and hospital-based care and need for medication4、lifelong health術(shù)后并發(fā)癥術(shù)后并發(fā)癥是導(dǎo)致術(shù)后患病和死亡的最主要因素。術(shù)后并發(fā)癥Hypoxemia低氧血癥Hypercapnia高碳酸血癥increased work of breathing呼吸做功增加increased work of the heart心臟做功增加fluid and electrolyte imbalances水電解質(zhì)不平衡metabolic and blood sugar abnor

7、malities代謝及血糖異常reduced cardiac output心輸出量減少術(shù)后并發(fā)癥reduced blood volume血流量減少cardiac dysrhythmias心律失常reduced tissue perfusion and oxygenation組織的灌注和氧合下降anemia貧血pain 疼痛alveolar hypoventilation肺泡的換氣不足airway collapse氣道塌陷術(shù)后并發(fā)癥atelectasis肺不張physiological shunting生理性分流ventilation and perfusion mismatching通氣與血流

8、灌注不匹配impaired mucociliary transport粘液纖毛系統(tǒng)的損害accumulation of mucus and stasis分泌物的潴留pneumonia肺部感染thromboemboli血栓術(shù)后并發(fā)癥pulmonary embolus肺栓塞coagulopathies凝血功能障礙sepsis敗血癥shock休克multiorgan system failure多器官衰竭引起術(shù)后并發(fā)癥的因素手術(shù)因素麻醉因素疼痛制動和臥床藥物因素患者因素其他因素手術(shù)因素type of surgery手術(shù)方式surgical procedure手術(shù)過程operative incisio

9、n手術(shù)切口position assumed during surgery術(shù)中體位麻醉因素duration of anesthesia 麻醉持續(xù)時間degree of anesthesia 麻醉的程度type of anesthesia麻醉的方式疼痛制動和臥床藥物因素麻醉劑肌松劑止痛藥患者因素age年齡sex性別smoking history吸煙史obesity肥胖nutritional status營養(yǎng)狀況psychosocial situation心理狀況Othersuse of mechanical ventilation機(jī)械通氣fluid loss and drainage體液的丟失和引

10、流Role of the physiotherapist: 物理治療師的角色Pre-op assessment術(shù)前評估pre-op risk factors:術(shù)前風(fēng)險因素Age 年齡smoking history 吸煙史previous history既往史（高血壓、糖尿病、呼吸系統(tǒng)疾病、心血管系統(tǒng)疾病）sputum and cough 咳&痰body weight (obesity) 體重（肥胖）cardio-pulmonary fitness (exercise tolerance)心肺適能（運(yùn)動耐力）pulmonary function testing肺功能測試（VC、FEV1、MVV)

11、nutrition status營養(yǎng)狀況Pre-op considerations 術(shù)前考慮Purple目的：knowledge of the surgical procedure 掌握手術(shù)流程prediction of high risk patients 預(yù)期高風(fēng)險患者Risk assessment (prediction) tool風(fēng)險評估工具Complications requiring physiotherapy interventions:需要物理治療干預(yù)的并發(fā)癥Effect of drugs藥物效果Effect of pain疼痛效果Effect of immobility制動效

12、果Effect of surgery手術(shù)效果respiratory system呼吸系統(tǒng) FRC 功能殘氣量 mucociliary activity粘膜纖維運(yùn)動 ventilation (pain)通氣（痛）musculo-skeletal sys.肌肉骨骼系統(tǒng) muscle length & strength肌肉長度和力量 gastric-motility胃動力circulatory system循環(huán)系統(tǒng) blood flow (DVT)血流Pre-op treatment 術(shù)前干預(yù)Education教育：establish rapport / education/ teaching of

13、 certain skills 建立關(guān)系/教育/傳授相關(guān)技能Communication 交流breathing techniques 呼吸技巧secretion removal techniques去除分泌物的技巧Pre-op treatment 術(shù)前干預(yù)Treatment治療：Goal directed mobilization目標(biāo)導(dǎo)向的活動Frequency as indicated 頻率：range from 1 to 2 每天1至2次治療treatments / day for weeks持續(xù)數(shù)周Pre-operative role 術(shù)前職責(zé)problem identification

14、 問題確認(rèn)risk prediction 風(fēng)險評估establish rapport 建立關(guān)系treatment if necessary 必要的治療education / advice 教育/建議Intra-operative consideration 手術(shù)期間考慮type of anaesthesia 麻醉類型duration of anaesthesia 麻醉時間duration of surgery手術(shù)時間haemodynamicchanges during surgical procedures 手術(shù)步驟中血液動力的改變Post-operative management 術(shù)后管理P

15、urple目的：improve/maintain ventilation 提高/保持通氣improve/maintain lung volume提高/保持肺容量improve circulation 提高循環(huán)improve/maintain muscle length, strength, joint range提高/保持肌肉長度，力量，關(guān)節(jié)活動范圍optimise mobility 優(yōu)化活動能力Post-operative management 術(shù)后管理Positioning 體位管理pain relief疼痛緩解(timing, what drug, which route) 時間、藥物、路徑application of appropriate techniques for improvement of lung volume提高肺容量的相關(guān)技巧的應(yīng)用(indications and contra-indications, precautions)適應(yīng)癥和禁忌癥預(yù)防措施Post-operative management 術(shù)后管理oxygen therapy 氧氣療法 (FiO2, 吸氧分?jǐn)?shù)humidification濕度, delivery system傳送系統(tǒng),