【RAR】【免費電子書】麻省總院臨床麻醉手冊第6版 - 醫(yī)學(xué)資源下載
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上傳日期：2012-11-01 18:29:29

General considerations. The incidence of postoperative pulmonary complications is second only to cardiovascular complications as a cause of perioperative mortality. These complications are related to the type and severity of respiratory disease; the site, duration, and magnitude of the surgical procedure; and coexisting extrapulmonary diseases. Patients with significant chronic pulmonary disease are at greater risk for postoperative respiratory failure than the general population, because anesthesia and surgery more easily produce hypoventilation, hypoxemia, and retention of secretions in such patients. Patients with moderate to severe chronic lung disease and those having thoracic and upper abdominal operations have an increased morbidity and mortality rate. Postoperative morbidity and mortality can be reduced by identifying patients at risk for perioperative respiratory complications, optimizing their medical therapy, and instituting a program of chest physiotherapy before and after surgery. Classification of pulmonary disease Obstructive airway diseases are characterized by abnormal expiratory gas flow rates. The airflow limitation can be structural or functional. Chronic obstructive pulmonary disease (COPD) is airflow obstruction attributable to emphysema (“pink puffer”) or chronic bronchitis (“blue bloater”). Emphysema is due to abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destructive changes of the alveolar wall. This leads to loss of the normal elastic recoil of the lung with subsequent premature airway closure at higher than normal lung volumes during exhalation. Chronic bronchitis is defined as the presence of productive cough for at least 3 months in each of 2 successive years in a person in whom the excessive secretions are not due to other diseases. The most common precipitant is cigarette smoking. Asthma is defined as episodic variable airflow obstruction. Asthma is an inflammatory disease in which a complex cascade of cellular and chemical media

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