麻醉概論內(nèi)容(教學(xué)大綱)麻醉學(xué)的概念麻醉學(xué)的工作范疇麻醉方法的分類麻醉前病人的訪視各種麻醉方法訪視重點(diǎn)麻醉學(xué)

麻醉學(xué)是研究消除病人疼痛，保證病人安全，為手術(shù)創(chuàng)造良好條件的一門學(xué)科。麻醉工作的范疇手術(shù)麻醉麻醉恢復(fù)和重癥監(jiān)護(hù)治療急救復(fù)蘇疼痛治療及各種麻醉治療科研干部培訓(xùn)和教學(xué)麻醉方法的分類全身麻醉吸入、靜脈、靜吸局部麻醉表面麻醉、局部侵潤(rùn)麻醉、局位區(qū)域麻醉、神經(jīng)阻滯（神經(jīng)干阻滯、神經(jīng)叢阻滯、蛛網(wǎng)膜下腔阻滯、硬膜外腔阻滯）針刺麻醉復(fù)合麻醉靜吸復(fù)合、硬膜外腔阻滯復(fù)合全麻TheScopeofAnaesthesia

ProvidinggeneralorregionalanaesthesiainsideandoutsidetheoperatingroomIntensivecareunitsRespiratorytherapydepartmentsRecoveryroom

9TheScopeofAnaesthesia

CardiopulmonaryresuscitationPostoperativepainreliefAnaestheticresearch,teachingmedicalstudents,andassumingadministrativeandleadershippositionsonthemedicalstaffsofmanyhospitalsandambulatorycarefacilities.

10ClassificationofAnaesthesiaMethodsGeneral

anaesthesia

InhalationanaesthesiaIntravenousanaesthesiaIntramuscularlyRectallyOrallyBalancedanaesthesia11ClassificationofAnaesthesiaMethodsRegionalAnaesthesia

IntrathecalanaesthesiaSubarachnoidblockEpiduralanaesthesiaCaudalblockNerveplexusblockGanglionblockNerveblockFieldblock

.12DefinitionofthepracticeofanaesthesiologyAssessing,consulting,andpreparingpatientsforanaesthesiaRenderingpatientsinsensibletopainduringsurgicalobstetric,therapeutic,anddiagnosticprocedures

13

DefinitionofthepracticeofanaesthesiologyMonitoringandrestoringhomeostasisinperioperativeandcriticallypatientsDiagnosingandtreatingpainfulsyndromesManagingandteachingofcardiacandpulmonaryresuscitation14

DefinitionofthepracticeofanaesthesiologyEvaluatingrespiratiryfunctionandapplyingrespiratorytherapyTeaching,supervising,andevaluatingtheperformanceofmedicalandparamedicalpersonnelinvolvedinanaesthesia,respiratorycare,andcriticalcare15

DefinitionofthepracticeofanaesthesiologyConductingresearchatthebasicandclinicalsciencelevelstoexplainandimprovethecareofpatientsintermsofphysiologicfunctionanddrugresponseInvolvementintheadministrationofhospitals,medicalschools,andoutpatientfacilitiesasnecessarytoimplementtheseresponsibilities16麻醉前病人訪視與檢查存在疾病擬行何種手術(shù)系統(tǒng)回顧手術(shù)史和麻醉史藥物過敏史藥物治療史家族史各種檢查和化驗(yàn)檢查頭面頸部呼吸系統(tǒng)循環(huán)系統(tǒng)消化系統(tǒng)泌尿系統(tǒng)神經(jīng)系統(tǒng)內(nèi)分泌系統(tǒng)全身狀況循環(huán)系統(tǒng)臨床表現(xiàn)心電圖心超屏氣試驗(yàn)運(yùn)動(dòng)試驗(yàn)呼吸系統(tǒng)臨床表現(xiàn)胸片或胸部CT肺功能血?dú)?/p>

消化系統(tǒng)泌尿系統(tǒng)臨床表現(xiàn)、肝功能臨床表現(xiàn)、腎功能神經(jīng)系統(tǒng)中樞神經(jīng)外周神經(jīng)頭痛、肌無(wú)力、運(yùn)動(dòng)障礙、神志異常等癲癇、重癥肌無(wú)力、假性腦瘤、巴金森病、多發(fā)性硬化癥等

內(nèi)分泌系統(tǒng)高血壓糖尿病甲亢腎上腺腫瘤

全身狀況消瘦肥胖低蛋白血癥貧血電解質(zhì)紊亂酸堿平衡紊亂ASA分級(jí)分級(jí)標(biāo)準(zhǔn)耐受力I級(jí)正常健康良好II級(jí)有輕度或中度的周身性疾病，日?；顒?dòng)輕度受限良好III級(jí)有嚴(yán)重的周身性疾病，日?；顒?dòng)明顯受限有一定危險(xiǎn)IV級(jí)有生命危險(xiǎn)的周身性疾病，已喪失活動(dòng)能力有很大危險(xiǎn)V級(jí)生命垂危難以維持24小時(shí)有極大危險(xiǎn)VI級(jí)腦死亡有極大危險(xiǎn)ASAclassificationI Anormalhealthypatientotherthansurgicalpathology-withoutsystemicdisease. II Apatientwithmildsystemicdisease–nofunctionallimitations. 27ASAclassificationIII Apatientwithmoderatetoseveresystemicdisturbanceduetomedicalorsurgicaldisease-somefunctionallimitationbutnotincapacitating. IV Apatientwithseveresystemicdisturbancewhichposesaconstantthreattolifeandisincapacitating. 27ASAclassificationV Amoribundpatientnotexpectedtosurvive24hourswithorwithoutsurgery. E Ifthecaseisanemergency,thephysicalstatusisfollowedbytheletter“E”-,“IIE”.27

AmericanSocietyofAnaesthesiologistsclassificationandperioperativemortalityrates

Class MortalityRateI 0.06-0.08% II0.27-0.4% III1.8-4.3% IV 7.8-23% V9.4-51% 28頭面頸體檢鼻孔、口腔（牙齒松動(dòng)或義牙、張口困難）頸部（活動(dòng)度、頸與軀干的長(zhǎng)度、氣管位置）麻醉前用藥鎮(zhèn)靜降低新陳代謝預(yù)防不良反應(yīng)輔助麻醉降低反射應(yīng)激性藥物種類鎮(zhèn)靜和催眠藥麻醉性鎮(zhèn)痛藥神經(jīng)安定藥抗膽堿藥抗組胺藥圍術(shù)期常用的監(jiān)測(cè)循環(huán)監(jiān)測(cè)呼吸監(jiān)測(cè)腦功能監(jiān)測(cè)腎功能循環(huán)監(jiān)測(cè)脈搏儀監(jiān)測(cè)頻率、強(qiáng)弱、節(jié)律血壓監(jiān)測(cè)有創(chuàng)、無(wú)創(chuàng)心電圖監(jiān)測(cè)指壓試驗(yàn)中心靜脈壓監(jiān)測(cè)肺動(dòng)脈嵌壓（PCWP）監(jiān)測(cè)尿量呼吸監(jiān)測(cè)氣道壓脈搏血氧飽和度血?dú)夥治鑫肼樽硭帩舛缺O(jiān)測(cè)呼氣末CO2濃度監(jiān)測(cè)腦監(jiān)測(cè)ICP監(jiān)測(cè)腦血流和腦代謝監(jiān)測(cè)昏迷深度監(jiān)測(cè)腦電圖監(jiān)測(cè)肌松監(jiān)測(cè)肌力起效的評(píng)估肌力恢復(fù)的評(píng)估各種麻醉方法訪視重點(diǎn)全身麻醉訪視重點(diǎn)Preoperativeassessment

(

Physicalexamination)AirwayPreoperativeassessment

(

Physicalexamination)Mentalspace:Thedistencefromthethyroidcartilagetotheinsideofthementum,measuredwhilethepatientsitswiththeneckinthesniffposition.Theoropharynxisexaminedwiththepatientinthesittingposition,withtheneckextended,tongueout,andphonating.MallampaticlassificationoftheoropharynxClassI:Softpalate,fauces,uvula,anteriorandposteriortonsillarpillarsClassII:Softpalate,fauces,uvulaClassIII:Softpalate,baseofuvulaClassIV:SoftpalateonlyIncreasedthelikelihoodofdifficultintubationAhigheroropharyngealclassAmentalspace<2finger-breadthsDiminishedneckextensionDecreasedtissuecomplianceLargetongueIncreasedthelikelihoodofdifficultintubationOverbiteLargeteethNarrowhigh-archedpalateDecreasedtemporomandibularjointmobilityShortthickneck椎管內(nèi)、神經(jīng)阻滯訪視重點(diǎn)ContraindicationsofSpinalAnaesthesia

Absolute:

Sepsis

Bacteremia

Skininfectionatinjectionsite

Hypovolemia

Coagulopathy

Therapeuticanticoagulation

Demyelinatingcentralnervesystemdisease

Increasedintracranialpressure

Psychosisordementia

Lackofconsent

ContraindicationsofSpinalAnaesthesiaRelative

Peripheralneuropathy

Mini-dose”heparin

Aspirinorotherantiplateletdrugs

Priorlumbarspinesurgery

Chronicbackpain

Certaincardiaclesions

Psychologicoremotionalinstability

Uncooperativepatients

Prolongedsurgery

Surgeryofuncertainduration

Surgicalteamresistancetoawakepatients

總結(jié)麻醉學(xué)

麻醉學(xué)是研究消除病人疼痛，保證病人安全，為手術(shù)創(chuàng)造良好條件的一門學(xué)科。麻醉工作的范疇手術(shù)麻醉麻醉恢復(fù)和重癥監(jiān)護(hù)治療急救復(fù)蘇疼痛治療及各種麻醉治療科研干部培訓(xùn)和教學(xué)麻醉方法的分類全身麻醉吸入、靜脈、靜吸局部麻醉表面麻醉、局部侵潤(rùn)麻醉、局位區(qū)域麻醉、神經(jīng)阻滯（神經(jīng)干阻滯、神經(jīng)叢阻滯、蛛網(wǎng)膜下腔阻滯、硬膜外腔阻滯）針刺麻醉復(fù)合麻醉靜吸復(fù)合、硬膜外腔阻滯復(fù)合全麻麻醉前病人的訪視麻醉前病人訪視與檢查存在疾病擬行何種手術(shù)系統(tǒng)回顧手術(shù)史和麻醉史藥物過敏史藥物治療史家族史各種檢查和化驗(yàn)檢查頭面頸部呼吸系統(tǒng)循環(huán)系統(tǒng)消化系統(tǒng)泌尿系統(tǒng)神經(jīng)系統(tǒng)內(nèi)分泌系統(tǒng)全身狀況ASA分級(jí)分級(jí)標(biāo)準(zhǔn)耐受力I級(jí)正常健康良好II級(jí)有輕度或中度的周身性疾病，日?；顒?dòng)輕度受限良好III級(jí)有嚴(yán)重的周身性疾病，日?；顒?dòng)明顯受限有一定危險(xiǎn)IV級(jí)有生命危險(xiǎn)的周身性疾病，已喪失活動(dòng)能力有很大危險(xiǎn)V級(jí)生命垂危難以維持24小時(shí)有極大危險(xiǎn)VI級(jí)腦死亡有極大危險(xiǎn)各種麻醉方法訪視重點(diǎn)GeneralAnaesthesia

(

Physicalexamination)Mentumspace:Thedistencefromthethyroidcartilagetotheinsideofthementum,measuredwhilethepatientsitswiththeneckinthesniffposition.Theoropharynxisexaminedwiththepatientinthesittingposition,withtheneckextended,tongueout,andphonating.MallampaticlassificationoftheoropharynxClassI:Softpalate,fauces,uvula,anteriorandposteriortonsillarpillarsClassII:Softpalate,fauces,uvulaClassIII:Softpalate,baseofuvulaClassIV:SoftpalateonlyIncreasedthelikelihoodofdifficultintubationAhigheroropharyngealclassAmentalspace<2finger-breadthsDiminishedneckextensionDecreasedtissuecomplianceLargetongueIncreasedthelikelihoodofdifficultintubationOverbiteLarge