课件参考讲稿

Traumaticruptureoftheurinarybladderinacat ClinicforsmallanimalsurgeryandG.GradnerGillesDupréLaurentFindjiMucousmembranespaleInnerbodytemperature37.6(38.0°-39.3°)体内温度37.6°Pulse160108-132beats/minute)脉搏Respiratoryrate60(20-30呼吸次数60次/Initialtreatment最初Ringerssolution林格液40Hetastarch:5ml/kgwithin15羟乙基淀粉：5ml/kgHeptadon0.05OxygenHematologyand血液学和HK45%(30-44),TP8.2g/dl(6-ALT100U/l(0-53),ALP87U/l(0-BUN119mg/dl(0-39),Creatinin4.7(0.7-Glucose413mg/dl(62-Natrium141mmol/l(145-158),Kaliummmol/l(3.8-4.5),Chlor145mmol/l(117-Abdominocentesis Blood血HK HKTP2.0 TP8.2Crea21.5 Crea4.7CreatininCreatininr[r[

骨长 球

Urethral 破Bladder 破

Kidneyrupture肾破裂Kidney/Ureter肾/UrinaryFreeLocationofthetearCorrectionofElectrolytedisturbances离子平衡Acid-basedisturbances酸碱平衡Providedrainageof PreventfurtherreabsorptionofRehydrationanddehydrationxkgBWL

thirstystickymucousmembranes8-12lossofskinturgorCRT12-15shockdeathmaintenance维持量2ml/kg ,diarrhea腹泻ElectrolyteImbalancesElectrolyteImbalancesMildtomoderatePotassium-freefluids:0.9%无钾离子Ca-Gluconate10%0.5-1.0mL/kgduring20MonitorECG监测MonitorECG监测ElectrolyteImbalancesSevereHyperkalaemia严重高血钾(>7mEqNaHCO3=0.3xBExkgBWmEqNaHCO3=0.3xBExkgBW11mg/kg0.5IU/kg0.5IU/kgfollowedbyserumconcentration监测血糖浓度后给予胰岛素0.5Acid-baseImbalancesMildacidosisSevereacidosispH<7.2orHCO3-<12GiveBicarbonate!mEqmEqNaHCO3=0.3xBExkgGive½in20minutes在20分钟内给1/2Restin4-6hoursifneeded若需要4－6hrAbdominaldrainageBloodsupplyurinary血液PostoperativeTreatmentInfusiontoincreasediuresisPainmanagement(Methadon, NasoesophagealtubeforfeedingCouldwehaveremovedthetraumatizedurinarybladdertissue?我们是否切除外伤 Yes,upto80%oftheurinarybladdercanberesected,butyouhavetotakecareofthetrigonumvesicae.是的，可以切除80％ 三角Howcouldwehavereinforcedthe怎样加强缝Omentum,SerosalpatchHowmanylayersaretobesutured?缝合多少Oneortwolayerclosure单层或双Isthisasurgical是否需要紧急外科手MedicalMedicalemergencyConclusion结Consider„atypical“clinical ItConsider„atypical“clinical