inhalation anesthesia

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不同胎龄早产儿行眼底检查时吸入全身麻醉的效果及安全性

不同胎龄早产儿行眼底检查时吸入全身麻醉的效果及安全性目的觀察不同胎龄早产儿行眼底检查时吸入全身麻醉的效果及安全性。

方法选取2016年10月～2017年10月我院眼科门诊收治的62例矫正胎龄为33～64周的视网膜病变早产儿作为研究对象，根据矫正胎龄的不同将其分为A组和B组，每组各31例。

A组患儿的矫正胎龄为33～44周，B组患儿的矫正胎龄>44～63周。

两组患儿在进行眼底检查时，其麻醉方法为给予诱导吸入6%的七氟烷。

将体动停止时间作为麻醉诱导时间，在2倍诱导时间后给予患儿七氟烷麻醉维持浓度。

两组患儿的维持浓度起始浓度均为3%，吸入浓度的等差调整幅度为每次上调0.5%。

记录两组患儿的麻醉持续时间、麻醉诱导时间、麻醉停止后的苏醒时间，观察麻醉诱导及维持期间两组患儿是否有呕吐、呛咳等不良反应。

在眼底检查结束1 h后，观察两组患儿饮水及喂奶期间是否有呕吐、呛咳等现象。

结果A组患儿的平均麻醉维持浓度为（2.4±0.5）%，明显低于B组的（3.1±0.7）%，差异有统计学意义（P＜0.05）。

A组患儿的平均麻醉维持时间、平均麻醉清醒时间分别为（493.7±104.5）、（352.6±157.3）s，B组患儿分别为（492.8±114.6）、（367.1±155.3）s，两组患儿的平均麻醉维持时间、平均麻醉清醒时间比较，差异无统计学意义（P>0.05）。

A组患儿的平均麻醉诱导时间为（56.4±13.1）s，明显短于B组的（75.6±13.2）s，差异有统计学意义（P＜0.05）。

结论在早产儿吸入七氟烷麻醉行眼底检查时，应根据患儿的不同胎龄情况及需要严格控制吸入浓度，以保证患儿的生命安全。

[Abstract] Objective To observe the effect and safety of inhalation of general anesthesia for fundus examination in preterm infants at different gestational ages. Methods A total of 62 preterm infants with retinopathy with corrected gestational age of 33-64 weeks from October 2016 to October 2017 treated in the ophthalmology clinic of our hospital were selected as objects. They were divided into group A and group B according to the different gestational age，with 31 cases in each group. The corrected gestational age of preterm infants in group A was 33-44 weeks，and the corrected gestational age of preterm infants in group B was over 44-63 weeks. In the two groups of children with retinopathy，the fundus examination was performed with inhalation of 6% of Sevoflurane. The body motion stop time was used as the induction time of anesthesia，and the concentration of Sevoflurane anesthesia was given after 2 times of induction time. The initial concentration of maintenance concentration of the two groups was 3%，and the adjusted range of the inhalation concentration was 0.5%. The duration of anesthesia，the time of anesthesia induction，and the awakening time after the cessation of anesthesia were recorded in the two groups，and the adverse reactions such as vomiting and cough were observed during the induction and maintenance of anesthesia in the two groups. After 1 h of the end of fundus examination，whether there were vomiting and cough during drinking and feeding during in the two groups were observed. Results The average maintenance concentration of group A was （2.4±0.5）%，which was significantly lower than that of group B accounting for （3.1±0.7）%，and the difference was statistically significant （P＜0.05）. The average anesthesia maintenance time and theaverage anesthesia waking time in group A was （493.7±104.5）s and （352.6±157.3）s respectively，the group B was （492.8±114.6）s and （367.1±155.3）s respectively，and there were no statistically significant differences in average anesthesia maintenance time and the average anesthesia waking time between two groups （P>0.05）. The average anesthesia induction time of the group A was （56.4±13.1）s，which was significantly shorter than that in the group B accounting for （75.6±13.2）s，and the difference was statistically significant （P ＜0.05）. Conclusion In order to ensure the safety of the children，Sevoflurane inhalation anesthesia in preterm infants should be strictly controlled according to the conditions of different gestational ages and the needs of the children.[Key words] Different gestational age；Preterm infants；Fundus examination；Sevoflurane inhalation anesthesia；Anesthetic effect；Safety近年来，随着现代医疗技术的不断发展和医疗卫生条件的不断改善，新生儿早产儿的存活率明显提高[1]。

第三章麻醉(Anesthesia)

第三章麻醉（Anesthesia）关于麻醉的基本概念主要从外科手术方面讲述，在药理学中还要给同学们讲述。

本章主要是阐述麻醉药在外科手术中的应用及针刺和电针麻醉，希望同学们先预习有关的药理方面的内容。

第一节、麻醉的概念第二节、麻醉的分类第三节、局部麻醉一、局部麻醉药二、麻醉方法第四节、电针麻醉一、概述二、临床应用第五节、全身麻醉一、全身麻醉的分期二、非吸入麻醉三、吸入麻醉四、麻醉的并发症及抢救第六节、镇静、镇痛和肌松弛药的临床应用第一节麻醉的概念一、麻醉概念：①使畜体在一定外因作用下，在一定时间和一定生理范围内所呈现的抑制优势过程。

这种抑制优势过程在临床上，表现为中枢系统对外界刺激反应的减弱或消失而导致机体局部感觉迟钝或消失，直至伴有肌肉松驰和全身知觉得完全消失，从而使动物安静和不反抗地接受治疗。

②或就是用药物和物理的方法，使动物局部或全身的感觉暂时地迟钝以至丧失。

二、麻醉的目的：除在于避免施术动物的骚动和挣扎，解除手术对动物机体的不良刺激外，其实际意义还在于：1、使病畜失去疼痛感觉，以保持大脑皮层的正常抑制过程。

2、简化保定方法，避免手术人员或病畜发生意外损伤，及节省人力。

3、使病畜保持安静，以利于安全和细致地手术操作。

4、减少手术创的污染机会，更好的达到无菌要求，给手术创造进一步条件。

5、避免手术的不良刺激，提供保护性疗法的条件，防止外伤性休克。

三、注意问题：1、麻醉良好的效果，取决于把麻醉方法与施术动物的具体情况相结合。

因为麻醉要有一定的毒性，它的过量及不足均给机体带来不良影响。

所以根据施术动物及手术性质，考虑是否麻醉，用哪种药品进行麻醉。

2、施术动物，因其种属不同，对疼痛等感觉的敏感性也不同，一般来讲，马属动物敏感性较强，牛羊次之。

养猪等小动物简单手术如去势通常不进行麻醉，牛的中小手术，如胆囊手术，进行局部麻醉即可。

而马属动物中等以上手术，都需要做全身麻醉。

而同种家畜由于神经类型不同，对疼痛刺激的敏感性也不一样，通常兴奋型的家畜就比较敏感。

IV vs IH

静脉麻醉的优势
ADVANTAGES OF INTRAVENOUS ANESTHESIA
7.苏醒期很少恶心呕吐
RARELY OCCURRED NAUSING & VOMITING DURING EMERGENCY
8.无需高档麻醉机的高额投资
NOT NECESSARY TO INVEST ON VERY EXPENSIVE ANESTHESIA MACHINE
静脉麻醉与吸入麻醉-谁代表未来？
INTRAVENOUS vs.INHALATIONAL ANESTHESIA
-WHO IS FUTURE?
上海第二医科大学附属瑞金医院麻醉科
于布为
BUWEI YU DEPARTMENT OF ANESTHESIOLOGY RUIJIN HOSPITAL,SHANGHAI SECOND MEDICAL UNIVERSITY
静脉麻醉的相对不足
RELATIVE DISADVATAGES OF INTRAVENOUS ANESTHESIA
4. 给药后麻醉药必须在体内经过完整的药物代谢过程
INTRAVENOUS ANESTHETICS MUST BE METABOLIZED AFTER INJECTION
总结 CONCLUSION
静脉麻醉的优势
ADVANTAGES OF INTRAVENOUS ANESTHESIA
1. 安全性高
HIGHLY SAFETY
2. 病人舒适
PATIENT VERY COMFTABALE
静脉麻醉的优势
ADVANTAGES OF INTRAVENOUS ANESTHESIA
3. 诱导平稳迅速
VERY SMOOTH & QUICK INDUCTION

麻醉(anesthesia)

麻醉（anesthesia）一、概述麻醉学的发展古代临床麻醉学的发展：鸦片、酒精、放血、麻沸散、洋金花。

现代麻醉学的发展：美国牙医Morton于1846年施行乙醚吸入麻醉。

1885年Gorning介绍硬脊膜外麻醉。

1898年August Bier介绍腰麻，并第一次将CoCaine注入病人的椎管内作脚的截肢手术。

1920年气管内插管术的应用。

90年代彩色Dopple 将要作为无损伤监测心功能，动态观察的手段广泛用于临床麻醉。

第一节绪论一、麻醉（anesthesia）：用药物或非药物，使病人整个机体或机体的一部分暂时失去知觉，以达到无痛的目的。

多用于手术或某些疼痛的治疗。

麻醉的基本任务是消除手术所致的疼痛问题。

二、麻醉学（Anesthesiology）：研究消除病人手术疼痛，保证病人安全，为手术创造良好条件的一门科学，其他还包括急救复苏、重症监测和治疗、急性及慢性疼痛的治疗等。

三、临床麻醉方法分类：1、全身麻醉：麻醉药作用于中枢NS，使周身不感到疼痛。

①吸入全身麻醉（inhalation anesthesia）②静脉全身麻醉（intravenous）2、局部麻醉（Local anesthesia）：麻醉药作用于外周神经时，使躯体某部位产生麻醉作用。

①表面麻醉：喷、洒、涂、敷粘膜②局部浸润麻醉：N末稍阻滞③区域阻滞：N于④神经阻滞：N丛3、椎管内阻滞（intrathecal block）①蛛网膜下腔阻滞②硬脊膜外腔阻滞③骶管阻滞4、复合麻醉（combined anesthesia）：又称平衡麻醉（balanced anesthesia），将几种麻醉方法联合采用，称为复合麻醉。

5、基础麻醉（basal anesthesia）：麻醉前使病人进入类似睡眠状态，以利于其后的麻醉处理，这种麻醉前的处理称为基础麻醉。

第二节麻醉前准备和麻醉前用药（一）麻醉前准备1、掌握病情：a：麻醉前必须视诊病人，熟悉病史，了解手术史与麻醉史，烟酒嗜好，有无特殊药物使用史，如降压药，洋地黄等；以及药物过敏史。

全身麻醉ppt医学课件

阿司匹林、扑热息痛）第二阶梯为弱阿片类药物加减辅助药物（如：
可待因、曲马多）第三阶梯为中、强阿片类药物加减辅助药物
（如：吗啡、美施康定）
为什么癌痛治疗不用度冷丁？度冷丁在体内的代谢产物是"去甲哌替啶"，没有多少镇痛作用，体内代谢的半衰期很长（13-18小时），有神经毒性，可引起烦躁、焦虑、肌颤，癫痫大发作。除此之外，度冷丁镇痛作用只有吗啡的 1/8-1/10，注射使用有效时间短，只有2.5-3.5小时，反复注射可使局部组织硬化、发炎，易成瘾，且不符合三阶梯止痛治疗原则。
一、全身麻醉诱导
病人意识自清醒进入全麻状态直至手术开始，为麻醉诱导期。（1）预先氧合（preoxygenation）：面罩吸氧3分钟（2）去氮（denitrogenation）:排出体内的N2，肺泡吸入麻醉气体浓度迅速升高。（3）静注麻醉药、气管内插管。
二、全身麻醉的维持
（1）任务：维持适当深度麻醉和循环、呼吸功能的稳定。
误吸、药物中毒、新生儿窒息。
二、插管用具的准备
喉镜、气管导管及管芯、牙垫、喷雾器、吸引器
三、经口腔明视插管术
1、右手撑开口腔，左手持镜由口腔的右边放入，头过度后仰，当喉镜移向口腔中部时，舌头便自动被推向左侧，看到悬雍垂，挑起会厌，暴露声门。（见图）
2、右手持管，将导管尖插入声门4～5cm。 3、拔出管芯，放置牙垫，退出喉镜 4、接麻醉机或简易呼吸器，听诊两肺呼吸音一
四、全麻期间呼吸、循环管理五、应用麻醉机注意事项：熟悉机器性能、
常规检查
1、掌握适应症及禁忌症 2、根据需要选择不同药物 3、脱敏感组滞 4、与吸入药协同作用 5、无麻醉、阵痛作用 6、拮抗药 7、加强呼吸管理

外科专业英语词汇大全

外科专业英语词汇bloodtransfusion输血Abloodvolume血容量abscess脓肿bodyfluidbalance(isohydria)acid-basebalance酸碱平衡体液平衡acidosis酸中毒bowelclamptowelclamp肠钳active巾钳compression-decompressionCPR主动brachialplexusblock臂丛神式按压-减压心肺复苏经阻滞acutephlegmon急性蜂窝织炎bradycardia心动过缓advancedlifesupport进一步bronchiospasm支气管痉挛生命支持bupivacaine布比卡因amide酰胺类Canalgesia无痛法、止痛法carbunclecarbunculosis痈痈analgesic止痛的、痛觉缺失的病analgetic止痛药、镇痛剂cardiacarrest心跳骤停anaphylacticreaction过敏反CardiacOutput,CO心排血量应cardiogenicshock心源性休克anaphylacticallergicshock过CardiopulmonaryResuscitation,敏性休克CPR心肺复苏术anesthesiology麻醉学caudalanethesia骶麻anestheticcomplications麻醉CentralVenousPressure,CVP中并发症心静脉压anestheticrecoveryroom麻醉cerebralresuscitation脑复苏恢复室clinicalanesthesia临床麻醉arachnoidmater蛛网膜colloidalsolution胶体液artificialbreathing人工呼吸combinedbalancedasepsisantisepsis无菌、无菌anesthesia复合麻醉法、无菌术抗菌术CoronaryPerfusionPressure, BCPP冠状动脉灌注压bacteremia菌血症crystalsolution晶体液balancedsaltsolution平衡盐D溶液defibrillation除颤basalanesthesia基础麻醉depolarizingmusclebasalenergyexpenditure基础relaxant去极化类肌松剂能量消耗量diazepian安定basiclifesupport基本生命支dicaine的卡因持硬膜外麻醉epiduralanesthesia bellydrationtreatment腹水治蛛网膜下腔麻醉subarachnoid疗anesthesiabloodgasanalysis血气分析diffusionanoxia弥散性缺氧bloodpressure(BP)血压DisseminatedIntravascular1Coagulation(DIC)弥漫性血管内凝血敏反应dissociativeanesthesia分离麻hypokalemia低钾血症醉hypotensionn低血压氯胺酮ketaminehypothermia低体温diuretic利尿剂hypotonicdehydration低渗性drainage引流缺水droperidol氟哌利多hypovolemicshock低血容量性休duralmater硬脑膜克Ehypoxemia低氧血症Electrocardiogram,ECG心电图IElectromechanicalDissociation,incisionexcisionEMD电机械分离resection切口、切开切除(小)大elementaldiet要素饮食切除emergencyoxygenation紧急氧incisionalhernia切口疝合infection感染epiduralanesthesia硬膜外麻infiltrationanesthesia浸润麻醉醉erysipelaserysipeloid丹毒inhalationanesthesia吸入麻醉类丹毒injury损伤essential(basic)surgicalIntensiveCareUnit,ICU重症technique手术基本操作监护病房essentialamino-acid必须氨基interposedabdominal酸compressionCPR插入性压腹心肺复ester酯类苏boricacid硼酸盐intrathecalanesthesia椎管内etomidate依托咪酯麻醉exposure暴露切开止血缝合intravenousanesthesia静脉麻打结醉external-chestcardiacisotonicdehydration等渗性缺compression胸外心脏按压水Fisotonicsaline等渗盐水fentanyl芬太尼Kfuruncle疖疖病ketamine氯胺酮GLgeneralanesthesia全身麻醉laryngospasm喉痉挛Hlidocaine利多卡因hematoma血肿localanesthesia局部麻醉hemorrhagicshock失血性休克localanesthetics局麻药humanmentality人的智力M hyperkalemia高钾血症malformation畸形hypersensitivityreaction高malnutrition营养不良2metabolicacidosis代谢性酸中preoperativepreparation术前毒准备metabolicalkalosis代谢性碱中pre-shockstage休克前期毒procaine普鲁卡因microcirculation微循环prolongedlifesupport延续生midazolam咪唑安定命支持minimumalveolarpropofol异丙酚concentration最低肺泡有效浓度PulmonaryArterialWedgemornitoringduringPressure,PAWP肺动脉楔压anesthesia麻醉监测pyemia脓血症、脓毒症motornerve运动神经Rmusclerelaxant肌松剂regionalfieldblockNanesthesia区域阻滞麻醉nerveinjury神经损伤regurgitation反流neurogenicshock神经性休克ropivacaine罗匹卡因nitrogenbalance氮平衡S nitrousoxide一氧化亚氮(笑scalpelclampscissors气)retractor手术刀血管钳手术剪拉nondepolarizingmuscle钩(牵引器)relaxant非去极化类肌松剂scopolamime东莨菪碱nutritionsupport营养支持sensorynerve感觉神经Osepticshock感染性休克openairway开放气道septicemia败血症open-chestcardiacshockindex休克指compression开胸心脏按压shockstage休克期operativeindicationskinpreparation备皮contraindication手术指征禁忌证spinalanesthesiaoperativeinstruments手术器(subarachnoid)腰麻械stageofanalepsia苏醒期operativesurgicalfield手术stageofinduction诱导期区手术野stageofmaintain维持期osmoticpressure渗透压sterilization灭菌、消毒、绝育Psuctiontube吸引管piamater软脑膜surfaceanesthesia表面麻醉postduralpunctureheadachesurgicalhandscrub外科刷洗消(PDPH)腰麻穿刺后头痛毒手臂postoperativemanagement术后surgicalshock外科休克处理处置sympatheticparasympathetic preanestheticpreparation麻nerve交感副交感神经醉前准备Tpremedication麻醉前用药thiopentalsodium硫喷妥钠3totalenteralnutrition全胃肠气味odour1）没有none2）温和的内营养mild3）刺激的offensive totalparenteralnutrition全三、伤口周边WoundMargin 胃肠外营养1colour2、颜色、水肿的toxemia毒血症oedematoustoxicreaction毒性反应traceelement,四、伤口深度WoundDepthmicro-element微量元素五、红斑Eryghematrachealintubationcannula气1、呈现present2、离伤口的最管插管tumor,neoplasm肿瘤Uurinaryretention尿潴留远距离max，distancefromwound六、周围皮肤的性质General ConditionofSurroundingSkin1、干燥dry2、湿疹eczemaVvasoconstrictor血管收缩剂vasodilator血管扩张剂Ventricularfibrillation, VF心室纤维性颤动（室颤）ventricularstandstill心室停搏七、疼痛程度Pain1、没有0none温和1mild中等2moderate严重3severe2、间歇的intermittent恒定不变的constant换药时atdressingchange八、感染Infectionvertibralcanal椎管W1、疑似suspected2、伤口拭子waterandelectrolyte送检woundswabsent3、确诊病菌感balance水电解质平衡waterintoxication水中毒wounddehiscence伤口裂开woundhealing伤口愈合外科护理常用英语词汇染confirmed外科专业英语词汇Aabscess脓肿acid-basebalance酸碱平衡一、伤口的性质NatureofWoundBedacidosis酸中毒active1、健康肉芽形成healthycompression-decompressionCPR主动granulation2、上皮形成式按压-减压心肺复苏epithelialisation3、腐肉slough4、acutephlegmon急性蜂窝织炎黑色或棕色坏死组织black/brownadvancedlifesupport进一步necrotictissue5、其他（具体说明）specify生命支持二、渗出液Exuedate1、容量volume1）较少slight2）中等moderate3）大量large2、性质type1）血清的serous2）血污的bloodstained3purulent3）脓性的、应a mide酰胺类analgesia无痛法、止痛法analgesic止痛的、痛觉缺失的analgetic止痛药、镇痛剂anaphylacticreaction过敏反4anaphylacticallergicshock过CardiopulmonaryResuscitation,敏性休克CPR心肺复苏术anesthesiology麻醉学caudalanethesia骶麻anestheticcomplications麻醉CentralVenousPressure,CVP中并发症心静脉压anestheticrecoveryroom麻醉cerebralresuscitation脑复苏恢复室clinicalanesthesia临床麻醉arachnoidmater蛛网膜colloidalsolution胶体液artificialbreathing人工呼吸combinedbalancedasepsisantisepsis无菌、无菌anesthesia复合麻醉法、无菌术抗菌术CoronaryPerfusionPressure, BCPP冠状动脉灌注压bacteremia菌血症crystalsolution晶体液balancedsaltsolution平衡盐D溶液defibrillation除颤basalanesthesia基础麻醉depolarizingmusclebasalenergyexpenditure基础relaxant去极化类肌松剂能量消耗量diazepian安定basiclifesupport基本生命支dicaine的卡因持diffusionanoxia弥散性缺氧bellydrationtreatment腹水治DisseminatedIntravascular疗Coagulation(DIC)弥漫性血管内凝血bloodgasanalysis血气分析dissociativeanesthesia分离麻bloodpressure(BP)血压醉bloodtransfusion输血diuretic利尿剂bloodvolume血容量drainage引流bodyfluidbalance(isohydria)droperidol氟哌利多体液平衡duralmater硬脑膜bowelclamptowelclamp肠钳E巾钳Electrocardiogram,ECG心电图brachialplexusblock臂丛神ElectromechanicalDissociation,经阻滞EMD电机械分离bradycardia心动过缓elementaldiet要素饮食bronchiospasm支气管痉挛emergencyoxygenation紧急氧bupivacaine布比卡因合Cepiduralanesthesia硬膜外麻carbunclecarbunculosis痈痈醉病erysipelaserysipoloid丹毒cardiacarrest心跳骤停类丹毒CardiacOutput,CO心排血量essential(basic)surgicalcardiogenicshock心源性休克technique手术基本操作5essentialamino-acid必须氨基compressionCPR插入性压腹心肺复酸苏ester酯类intrathecalanesthesia椎管内etomidate依托咪酯麻醉exposure暴露切开止血缝合intravenousanesthesia静脉麻打结醉external-chestcardiacisotonicdehydration等渗性缺compression胸外心脏按压水Fisotonicsaline等渗盐水fentanyl芬太尼Kfuruncle疖疖病ketamine氯胺酮GLgeneralanesthesia全身麻醉laryngospasm喉痉挛Hlidocaine利多卡因hematoma血肿localanesthesia局部麻醉hemorrhagicshock失血性休克localanesthetics局麻药humanmentality人的智力Mhyperkalemia高钾血症malformation畸形hypersensitivityreaction高malnutrition营养不良敏反应metabolicacidosis代谢性酸中hypokalemia低钾血症毒hypotensionn低血压metabolicalkalosis代谢性碱中hypothermia低体温毒hypotonicdehydration低渗性microcirculation微循环缺水midazolam咪唑安定hypovolemicshock低血容量性休minimumalveolar克concentration最低肺泡有效浓度hypoxemia低氧血症mornitoringduringIanesthesia麻醉监测incisionexcisionmotornerve运动神经resection切口、切开切除(小)大musclerelaxant肌松剂切除Nincisionalhernia切口疝nerveinjury神经损伤infection感染neurogenicshock神经性休克infiltrationanesthesia浸润麻nitrogenbalance氮平衡醉nitrousoxide一氧化亚氮(笑inhalationanesthesia吸入麻醉气)injury损伤nondepolarizingmuscleIntensiveCareUnit,ICU重症relaxant非去极化类肌松剂监护病房nutritionsupport营养支持interposedabdominalO6openairway开放气道septicemia败血症open-chestcardiacshockindex休克指compression开胸心脏按压shockstage休克期operativeindicationskinpreparation备皮contraindication手术指征禁忌证spinalanesthesiaoperativeinstruments手术器(subarachnoid)腰麻械stageofanalepsia苏醒期operativesurgicalfield手术stageofinduction诱导期区手术野stageofmaintain维持期osmoticpressure渗透压sterilization灭菌、消毒、绝育Psuctiontube吸引管piamater软脑膜surfaceanesthesia表面麻醉postduralpunctureheadachesurgicalhandscrub外科刷洗消(PDPH)腰麻穿刺后头痛毒手臂postoperativemanagement术后surgicalshock外科休克处理处置sympatheticparasympathetic preanestheticpreparation麻nerve交感副交感神经醉前准备Tpremedication麻醉前用药thiopentalsodium硫喷妥钠preoperativepreparation术前totalenteralnutrition全胃肠准备内营养pre-shockstage休克前期totalparenteralnutrition全procaine普鲁卡因胃肠外营养prolongedlifesupport延续生toxemia毒血症命支持toxicreaction毒性反应propofol异丙酚traceelement,PulmonaryArterialWedgemicro-element微量元素Pressure,PAWP肺动脉楔压trachealintubationcannula气pyemia脓血症、脓毒症管插管Rtumor,neoplasm肿瘤regionalfieldblockUanesthesia区域阻滞麻醉urinaryretention尿潴留regurgitation反流Vropivacaine罗匹卡因vasoconstrictor血管收缩剂Svasodilator血管扩张剂scalpelclampscissorsVentricularfibrillation, retractor手术刀血管钳手术剪拉VF心室纤维性颤动（室颤）钩(牵引器)ventricularstandstill心室停scopolamime东莨菪碱搏sensorynerve感觉神经vertibralcanal椎管septicshock感染性休克W7waterandelectrolytebalance水电解质平衡waterintoxication水中毒wounddehiscence伤口裂开woundhealing伤口愈合8。

第六章--吸入麻醉

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CO2吸收器
是确保循环紧闭式麻醉无CO2重复吸入不可缺少的重要装置。
常用的CO2吸收剂有碱石灰（soda lime）和钡石灰（baralyme）。
1000 g碱石灰的有效吸收时间约为8 h。使用钠石灰前必须先筛净其粉末方可装罐使用。在对碱石灰的效能产生怀疑时，最可靠的依据
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通用的临床麻醉深度判断标准
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麻醉深度监测仪
脑电双频指数（bis-pectral index, BIS）对静脉麻醉深度的判断有一定意义
目前尚无一种能良好判断吸入麻醉深度的可靠指标
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麻醉期间观察和管理的重点
循环管理呼吸管理（保持呼吸道通畅）液体管理血糖、体温等的监测和处理有创监测在现代临床麻醉管理中的作用监测指标的观察及意义分析
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四、常用的吸入麻醉方法
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低流量紧闭吸入麻醉的理论基础
对吸入麻醉摄取的新认识。
在紧闭条件下，机体可通过心排量的改变来自动调节吸入麻醉的摄取量。

麻醉(Anesthesia)

Anaesthesia源于希腊文源于希腊文Anaisthesaesia 源于希腊文感觉消失” 合成的，没有感觉” 由an+aisthaesia合成的，“没有感觉”或“感觉消失” 合成的最早发现麻醉的是:扁鹊。最早发现麻醉的是扁鹊。扁鹊最早将麻醉应用于手术的是:华佗华佗(141-203年)，麻最早将麻醉应用于手术的是华佗年，沸汤口服死骨剔除术和剖腹产手术。口服，沸汤口服，死骨剔除术和剖腹产手术。 1840Morton首先采用了乙醚(Ether)作为全身麻醉首先采用了乙醚首先采用了乙醚作为全身麻醉剂并协助Warren用乙醚麻醉施行了很多大手术。用乙醚麻醉施行了很多大手术。剂并协助用乙醚麻醉施行了很多大手术 1892年德国年德国Schleich首先倡用可卡因作局部浸润麻首先倡用可卡因年德国首先倡用可卡因作局部浸润麻但毒性很大，不久由普鲁卡因代替。醉，但毒性很大，不久由普鲁卡因代替。
III期：外科麻醉期(手术期：深而规则的呼吸至呼吸停止。期外科麻醉期手术期深而规则的呼吸至呼吸停止。手术期)：总的特点：本能反射逐渐消失，呼吸规则，肌松，总的特点：本能反射逐渐消失，呼吸规则，肌松，呕吐和吞咽反射消失。又分为1、、、级和吞咽反射消失。又分为、2、3、4级。 IV期：延髓麻痹期、中毒死亡期。期延髓麻痹期、中毒死亡期。用药过量，反射全部消失，整个神经中枢明显抑制，用药过量，反射全部消失，整个神经中枢明显抑制，呼吸停止，心博散存或停止，血压降至休克血压以下(40-吸停止，心博散存或停止，血压降至休克血压以下(40-50mmHg柱)。柱。麻醉分期的评价: 麻醉分期的评价
3. 舒泰舒泰(Zoletil)：2-5mg/kg，iv；7-10mg/kg，：，；， im 缺点：头颈部震颤、僵硬；缺点：头颈部震颤、僵硬；无特效解药 4、丙泊酚：异丙酚（propofol）：非巴比妥类诱、丙泊酚：异丙酚（）：

吸入麻醉与静脉复合麻醉应用于乳腺癌根治手术中的效果

吸入麻醉与静脉复合麻醉应用于乳腺癌根治手术中的效果摘要：目的：对乳腺癌根治术患者使用吸入麻醉、静脉复合麻醉的效果做出分析。

方法：采用2021年11月-2022年12月这一时间段在本院诊治的乳腺癌患者作为研究对象，总例数84例，在随机抽样法方式下将患者划分成均为42例的两个组别，常规组患者使用吸入麻醉，研究组选择静脉复合麻醉+吸入麻醉，对比分析两组患者的麻醉效果，包括麻醉指标、临床指标、麻醉各时段疼痛情况三方面。

结果：研究组麻醉指标、临床指标均优于常规组；研究组麻醉各时段疼痛评分均低于常规组；组间差异具有统计学意义，P<0.05。

结论：为乳腺癌根治术患者实施吸入麻醉联合静脉复合麻醉，能够改善患者临床指标，降低患者麻醉各时段疼痛程度，临床应用价值较高。

关键词：吸入麻醉；静脉复合麻醉；乳腺癌根治术；疗效The effect of combined inhalation anesthesia and intravenous anesthesia in breast cancer radical surgeryWang Yanli, Tian LeiJinan Integrated Traditional Chinese and Western Medicine Hospital 271100[Abstract] Objective: To analyze the effects of inhalation anesthesia and intravenous combined anesthesia on breast cancer patients undergoing radical mastectomy. Methods: The breast cancer patients diagnosed and treated in our hospital during the period from November 2021 to December 2022 were taken as the research objects. The total number of cases was 84. The patients were pided into two groups with 42 cases under the random sampling method. The patients in theconventional group were treated with inhalation anesthesia, and the patients in the study group were treated with intravenous combined anesthesia+inhalation anesthesia. The anesthesia effects of the patients in the two groups were compared and analyzed, including anesthesia indicators, clinical indicators There are three aspects to the pain situation during each anesthesia period. Result: The anesthesia and clinical indicators of the study group were better than those of the conventional group; The pain scores of the study group during all anesthesia periods were lower than those of the conventional group; The difference between groups was statistically significant, P<0.05. Conclusion: Inhalation anesthesia combined with intravenous compound anesthesia for patients undergoing breast cancer radical surgery can improve the clinical indicators of patients, reduce the pain degree of patients at all stages of anesthesia, and has high clinical application value.Keywords: inhalation anesthesia; Intravenous compound anesthesia; Radical mastectomy for breast cancer; curative effect乳腺癌是一种恶性肿瘤，其发病机制比较复杂，发病率较高，最近几年该疾病的患者逐渐呈年轻化发展，为控制患者病情，临床需积极治疗，临床治疗主要以根治术为主，但患者身体较虚弱，治疗同时减轻患者疼痛感非常重要[1]。

吸入麻醉

麻醉机安全装置通气机废气处理装置全麻实施用具
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常用装置
气源
流量计
蒸发器贮气囊（呼吸囊）
呼吸管路（螺纹管、面罩）呼吸活瓣
CO2吸收装置
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麻醉挥发器 Evaporator
一种能将液态的挥发性麻醉药变成蒸汽，并按一定量输入麻醉环路的装置。
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低流量紧闭吸入麻醉的理论基础
对吸入麻醉摄取的新认识。
在紧闭条件下，机体可通过心排量的改变来自动调节吸入麻醉的摄取量。
吸入麻醉的药代动力学过程同静脉麻醉药完全一致。
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低流量紧闭吸入麻醉的实施过程
诱导后高流量去氮（但需注意血压变化）
麻醉维持过程中采取代谢流量
苏醒过程中可提前关闭挥发罐，但不应开大流量
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紧闭低流量吸入麻醉的缺点
需要特殊设备如果机械呼吸时缺乏对回路容量的监测，
就很容易发生通气不足对浓度的调节控制比较困难操作复杂有人认为，CO以及其他毒性产物会蓄积
在回路中
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麻醉剂英文

麻醉剂英文Anesthetic Agents: Understanding the BasicsIntroduction:Anesthesia plays a crucial role in modern medicine, enabling surgeons to perform complex procedures while ensuring patient comfort and safety. Anesthetic agents, commonly known as "麻醉剂" in Chinese, are substances used to induce loss of sensation or consciousness. This article aims to provide a comprehensive overview of anesthetic agents, their classification, and their roles in medical practice.Types of Anesthetic Agents:Anesthetic agents can be broadly classified into two categories: general anesthetics and local anesthetics.General Anesthetics:General anesthetics are medications that induce a reversible state of unconsciousness and loss of sensation throughout the entire body. They are administered intravenously or via inhalation. Common intravenous general anesthetics include propofol and etomidate, which act by enhancing the activity of inhibitory neurotransmitters in the brain.Inhalation anesthetics, such as sevoflurane and isoflurane, are delivered via a breathing mask and provide rapid induction and maintenance of anesthesia.Local Anesthetics:Unlike general anesthetics, local anesthetics act by blocking the transmission of nerve impulses in a specific area, numbing the region and allowing for painless surgical procedures. Local anesthetics can be administered topically, through infiltration, or via nerve blocks. Lidocaine and bupivacaine are commonly used local anesthetics due to their efficacy and safety profile.Mechanism of Action:The mechanism of action of anesthetic agents varies depending on the type. General anesthetics work by altering the functioning of neurotransmitters in the central nervous system, leading to inhibition of neuronal activity and loss of consciousness. Local anesthetics, on the other hand, block sodium channels in nerve fibers, preventing the conduction of pain signals.Clinical Applications:Anesthetic agents are used in various medical procedures, rangingfrom minor surgeries to major interventions. General anesthetics are indispensable in surgeries requiring complete unconsciousness, such as cardiac surgeries, abdominal surgeries, and neurosurgical procedures. Local anesthetics find utility in dental procedures, skin surgeries, and pain management during labor.Safety Considerations:While anesthetic agents are generally safe when administered by trained professionals, they are not without risks. Possible complications include allergic reactions, respiratory depression, cardiovascular instability, and postoperative nausea and vomiting. These risks are mitigated by careful patient selection, comprehensive preoperative assessment, and vigilant monitoring during anesthesia administration.Conclusion:In conclusion, anesthetic agents are essential tools in modern medicine, allowing for painless surgical interventions and ensuring patient comfort. Understanding the classification, mechanism of action, and clinical applications of these agents is crucial for healthcare professionals involved in anesthesia management. By balancing the benefits and risks, anesthetic agents contribute significantly to improving patient outcomes and enhancing the quality of healthcare delivery.Anesthetic AgentsIntroduction:Anesthesia is a critical component of modern medicine, allowing surgeons to perform procedures without causing pain or discomfort to patients. Anesthetic agents play a vital role in this process, providing temporary loss of sensation and consciousness. In this article, we will explore the various types of anesthetic agents commonly used in medical practice.Types of Anesthetic Agents:1. Local Anesthetics:Local anesthetics are primarily used to provide localized pain relief. They work by blocking the nerve signals in a specific area, numbing the region and preventing pain sensation. Commonly used local anesthetics include lidocaine, bupivacaine, and procaine. These agents are typically administered via injection or topical application.2. General Anesthetics:General anesthetics induce a reversible loss of consciousness, allowing surgeons to perform complex procedures without causing anydiscomfort to patients. These agents are usually administered through inhalation or intravenous injection. Some commonly used general anesthetics include sevoflurane, propofol, and desflurane.3. Regional Anesthetics:Regional anesthetics are used to numb larger areas of the body, such as an entire limb or a specific region. These agents block nerve signals along a specific nerve pathway, resulting in loss of sensation in the targeted area. Examples of regional anesthetics include epidural and spinal anesthesia, which are frequently used during childbirth or orthopedic surgeries.4. Intravenous Anesthetics:Intravenous (IV) anesthetics are administered directly into the bloodstream to induce sedation and relaxation. These agents work rapidly, allowing for quick onset and offset of anesthesia. Commonly used IV anesthetics include midazolam, propofol, and ketamine.5. Topical Anesthetics:Topical anesthetics are applied directly to the skin or mucous membranes to provide localized pain relief. These agents are commonly used during minor surgical procedures, dental work, or to alleviatediscomfort from skin conditions. Lidocaine and benzocaine are popular topical anesthetics utilized in medical practice.Safety and Considerations:While anesthetic agents are essential in modern medicine, it is crucial to consider their potential risks and side effects. Allergic reactions, respiratory depression, and interactions with other medications are some of the risks associated with anesthesia. Therefore, it is crucial for healthcare professionals to carefully evaluate a patient's medical history and tailor the selection and dosage of anesthetic agents accordingly.Conclusion:Anesthetic agents are invaluable tools in the field of medicine, ensuring patient comfort and safety during surgical procedures. From local anesthetics to general anesthetics, each type serves a specific purpose, allowing healthcare professionals to perform intricate surgeries and interventions without causing pain or distress. By understanding the different types of anesthetic agents and their applications, medical professionals can provide effective pain management and optimal patient care.。

麻醉ppt课件

三、药品、器械准备
麻醉用具麻醉药品麻醉机监测设备
ECG、NBP、SpO2 ABP、CVP、PAP、CO、EtCO2
特殊药品
-受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂以及硝酸酯类
抢救药品
atropine、ephedrine 、phenylepherine 、 epinepherine
阻滞消退顺序与阻滞顺序相反
➢ 交感神经＞感觉神经＞运动神经
脊神经在体表的节段分布
(四)椎管内麻醉对机体的影响
➢ 对呼吸的影响 ➢ 对循环的影响 ➢ 对体温的影响 ➢ 对其他系统的影响
三、椎管内麻醉方法
➢ 蛛网膜下腔阻滞 ➢ 硬膜外腔阻滞 ➢ 骶管阻滞 ➢ 蛛网膜下腔与腰段硬膜外联合阻滞
(一)蛛网膜下腔阻滞
缺点
可控性较差个体差异大镇痛作用较弱（氯胺酮例外）
常见吸入麻醉药
N2O （nitrous oxide）异氟烷（ isoflurane）七氟烷（sevoflurane）地氟烷（desflurane）
常用吸入麻醉药物理特性和麻醉效能
药物分子量
（D）
氧化亚氮 44
氟烷
194
75~100 400
150~225 200
起效时间（min）
15~20 5~15 10~20 10~20
作用时效（min）
产生中枢神经系统症状的阈剂量（mg/kg）
90~180
四、麻醉前用药
目的
镇痛(analgesia) 镇静（sedation）和催眠（hypnosis）抑制腺体分泌抑制不良反射
常用药物
安定镇静药催眠药（hypnotics）镇痛药（analgesics）抗胆碱药

不同麻醉方法在乳腺癌改良根治术中的比较

不同麻醉方法在乳腺癌改良根治术中的比较目的对比静吸复合麻醉和全凭静脉麻醉下置入第三代喉罩机械通气用于乳腺癌改良根治术的特点。

方法将60例择期单侧乳腺癌改良根治手术患者随机分成两组，静吸复合麻醉组（Ⅰ组），全凭静脉麻醉组（Ⅱ组），于麻醉前（基础）、插入喉罩1 min、切皮、腋窝清扫后5 min、拔出喉罩后1 min记录心率、平均动脉压、脉搏血氧饱和度，并记录术中及术后的相关并发症。

结果两组麻醉时间、手术时间差异无统计学意义（P>0.05），停药至拔管时间静吸复合麻醉组要明显短于全凭静脉麻醉组（P＜0.05），血流动力学平稳，均在正常波动范围内。

术后恶心、呕吐、躁动率发生率静吸复合麻醉组高于全凭静脉麻醉组，但差异无统计学意义（P>0.05）。

结论静吸复合麻醉和全凭静脉麻醉下置入第三代喉罩都可以安全地用于乳腺癌改良根治手术，术后并发症少，但前者拔管苏醒更快。

[Abstract] Objective To compare features of inhalation anesthesia and total intravenous anesthesia in the placement of third generation laryngeal mask （LM）mechanical ventilation for modified radical mastectomy. Methods 60 patients with unilateral breast cancer undergoing modified radical surgery were randomly divided into two groups：inhalation anesthesia group （Ⅰgroup），and total intravenous anesthesia group （Ⅱgroup）. Heart rate，mean arterial pressure and saturation of pulse oximetry of the two groups were obaserved before anesthesia （base），1 min after LM insertion，during incision，5 min after axillary dissection and 1 min after pulling out LM. Intraoperative and postoperative complications of the two groups were also recorded. Results The two groups were not significantly different in the duration of anesthesia and operative time （P>0.05）. From drug stop to extubation time the inhalation anesthesia group was significantly less than the total intravenous anesthesia group （P＜0.05），with stable hemodynamics within the normal fluctuation range in both groups. Incidence rates of postoperative nausea，vomiting and restlessness were higher in the inhalation anesthesia group than in the total intravenous anesthesia group，but the differences was not significant （P>0.05）. Conclusion Under both inhalation anesthesia and total intravenous anesthesia third generation LM can be safely used in modified radical breast surgery with few complications，but in terms of extubation awakaing the former is much faster.[Key words] Laryngeal mask；Anesthesia；Mechanical ventilation乳腺癌改良根治術手术时间通常较短，手术量大，为了缩短接台时间，要求麻醉医师做到麻醉诱导和苏醒迅速，同时还要确保患者生命体征平稳，不良反应发生率低。

吸入麻醉(双语)

inhalational anesthesia
六、吸入麻醉期间的管理
Management during inhalational anesthesia
㈠麻醉前准备preanesthetic preparation
Preanesthetic visit to assess the risks of anesthesia and surgery and to plan the anesthetic management. ● Anesthetics, equipment for monitoring anesthetic machine and intravenous fluids should be prepared.
6.对颅内压及 6.对颅内压及EEG的影响
Effects on ICP and EEG ●增加颅内压，异氟醚影响最小 increase ICP, and this action of isoflurane is the lowest in all volatiles. ●抑制EEG，安氟醚可引起痉挛性EEG改变
7.理想吸入麻醉药的特点理想吸入麻醉药的特点 Properties of the ideal inhalational anesthetic
• Pleasant odour, non-irritant to respiratory depression • low blood/solubility—rapid induction and recover from anesthesia • Neither flammable nor explosive • Producing unconsciousness with analgesia and some degree of muscle relaxation • Not be metabolized in the body, non-toxic, not provoke allergic reactions • Minimal depression of cardiovascular and respiratory system and not interact with the other drugs used commonly during anesthesia, e.g. catecholamines.