課件參考講稿

Traumaticruptureoftheurinarybladderinacat ClinicforsmallanimalsurgeryandG.GradnerGillesDupréLaurentFindjiMucousmembranespaleInnerbodytemperature37.6(38.0°-39.3°)體內(nèi)溫度37.6°Pulse160108-132beats/minute)脈搏Respiratoryrate60(20-30呼吸次數(shù)60次/Initialtreatment最初Ringerssolution林格液40Hetastarch:5ml/kgwithin15羥乙基淀粉：5ml/kgHeptadon0.05OxygenHematologyand血液學和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[

骨長 球

Urethral 破Bladder 破

Kidneyrupture腎破裂Kidney/Ureter腎/UrinaryFreeLocationofthetearCorrectionofElectrolytedisturbances離子平衡Acid-basedisturbances酸堿平衡Providedrainageof PreventfurtherreabsorptionofRehydrationanddehydrationxkgBWL

thirstystickymucousmembranes8-12lossofskinturgorCRT12-15shockdeathmaintenance維持量2ml/kg ,diarrhea腹瀉ElectrolyteImbalancesElectrolyteImbalancesMildtomoderatePotassium-freefluids:0.9%無鉀離子Ca-Gluconate10%0.5-1.0mL/kgduring20MonitorECG監(jiān)測MonitorECG監(jiān)測ElectrolyteImbalancesSevereHyperkalaemia嚴重高血鉀(>7mEqNaHCO3=0.3xBExkgBWmEqNaHCO3=0.3xBExkgBW11mg/kg0.5IU/kg0.5IU/kgfollowedbyserumconcentration監(jiān)測血糖濃度后給予胰島素0.5Acid-baseImbalancesMildacidosisSevereacidosispH<7.2orHCO3-<12GiveBicarbonate!mEqmEqNaHCO3=0.3xBExkgGive?in20minutes在20分鐘內(nèi)給1/2Restin4-6hoursifneeded若需要4－6hrAbdominaldrainageBloodsupplyurinary血液PostoperativeTreatmentInfusiontoincreasediuresisPainmanagement(Methadon, NasoesophagealtubeforfeedingCouldwehaveremovedthetraumatizedurinarybladdertissue?我們是否切除外傷 Yes,upto80%oftheurinarybladdercanberesected,butyouhavetotakecareofthetrigonumvesicae.是的，可以切除80％ 三角Howcouldwehavereinforcedthe怎樣加強縫Omentum,SerosalpatchHowmanylayersaretobesutured?縫合多少Oneortwolayerclosure單層或雙Isthisasurgical是否需要緊急外科手MedicalMedicalemergencyConclusion結(jié)Consider?atypical“clinical ItConsider?atypical“clinical