麻醉与器官保护
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
设同类药物中所有的药是相同的
??
Harm
Protection
Example - effect on contractility 举例 – 对心肌收缩力的影响
Royse CF, Liew DF, Wright CE et al. Persistent depression of contractility
Harm
Protection
Do you practice anaesthesia with the firm belief, that when you switch off the anaesthetic, that the effects are fully reversible and that no harm is
Are the effects reversible - e.g.brain? 这些影响可逆转吗 – 例如：脑？
Organ Function 器官功能
Time时间 Eye opening睁眼
OrienEtamtioonti定on向al情感 Cognitive认知
Recovery differences-other organs 恢复的差别 – 其他器官
Anesthesia & Organ
Protection 麻醉与器官保护
Effects of Anaesthesia on Organ Function 麻醉对于器官功能的影响
Organ Function 器官功能
Time时间
Liver肝脏 Kidney Gut肾脏，消化道 Vascular resistance血管阻力 Contractility收缩力 Respiration呼吸 Consciousness意识
What we do know 我们所知的：
? Anaesthetics alone can cause POCD in mice after repeated exposure反复使用麻醉药这一单一因素即可导致小鼠术 后认知功能的障碍
? Anaesthetics can alter hippocampal gene expression lasting weeks, indicating that longer term intracellular changes occurs麻醉药能够持续数周改变海马基因的表达，提示 发生了远期的细胞内改变
Baidu Nhomakorabea
Organ Function 器官功能
Time时间 Respiratory 呼C心吸a血rdi管ovasculNVaoramusietiang+恶心和
Range of recovery 恢复的范围
Organ Function 器官功能
Expectation Time时间 期望值 Range范围
Can anaesthetics cause harm? 麻醉是有害的吗？
Bianchi SL, Tran T, Liu C et al. Brain and behavior changes in 12-month-old Tg2576 and nontransgenic mice exposed to anesthetics. Neurobiol Aging 2007. Culley DJ, Yukhananov RY, Xie Z et al. Altered hippocampal gene expression 2 days after general anesthesia in rats. Eur J Pharmacol 2006;549:71-8.
? agitation躁动 ? disorientation定向障碍 ? postoperative cognitive dysfunction (POCD)术后认知功
能障碍 ? sometimes prolonged hypotension有时发生长时间的低
血压 ? cases of good versus bad recovery患者恢复有好有坏
and vasodilation with propofol
but not with sevoflurane or desflurane in rabbits. Anesthesiology 2008;108:87-93
Example- effect on MAP 举例 – 对平均动脉压的影响
Concept of organ protection 器官保护的概念
Are all anaesthetics all equal? 所有的麻醉药都一样吗？
Harm 伤害
Protection 保护
We should not assume that all anaesthetics are equal, nor
should we assume that all drugs from the same class are the same既不能假设所有的麻醉药是一样的，也不应该假
done to the patients? 实施麻醉时您是否坚信在停药后 麻醉药物的影响是否可以完全逆
转而对病人没有伤害？
If you said yes… then why do we get……… 如果你的回答是“YES”，那么为什么我
们还会遇到……..
? prolonged nausea and vomiting 术后长时间的恶心和呕 吐
? Requires a potential organ injury存在潜在 的器官损害因素
What we don't know- what is the trigger for harm 我们不知道的 – 导致伤害的诱因
是什么？
? Drug药物 ? Dose剂量 ? Depth麻醉深度 ? Duration用药时间 ? Repeated exposure反复用药 ? Patient susceptibility病人的易感性 ? Importance of co-morbidities并存疾病的重要性 ? Are all anaesthetics equal???所有的麻醉药都一样吗？
??
Harm
Protection
Example - effect on contractility 举例 – 对心肌收缩力的影响
Royse CF, Liew DF, Wright CE et al. Persistent depression of contractility
Harm
Protection
Do you practice anaesthesia with the firm belief, that when you switch off the anaesthetic, that the effects are fully reversible and that no harm is
Are the effects reversible - e.g.brain? 这些影响可逆转吗 – 例如：脑？
Organ Function 器官功能
Time时间 Eye opening睁眼
OrienEtamtioonti定on向al情感 Cognitive认知
Recovery differences-other organs 恢复的差别 – 其他器官
Anesthesia & Organ
Protection 麻醉与器官保护
Effects of Anaesthesia on Organ Function 麻醉对于器官功能的影响
Organ Function 器官功能
Time时间
Liver肝脏 Kidney Gut肾脏，消化道 Vascular resistance血管阻力 Contractility收缩力 Respiration呼吸 Consciousness意识
What we do know 我们所知的：
? Anaesthetics alone can cause POCD in mice after repeated exposure反复使用麻醉药这一单一因素即可导致小鼠术 后认知功能的障碍
? Anaesthetics can alter hippocampal gene expression lasting weeks, indicating that longer term intracellular changes occurs麻醉药能够持续数周改变海马基因的表达，提示 发生了远期的细胞内改变
Baidu Nhomakorabea
Organ Function 器官功能
Time时间 Respiratory 呼C心吸a血rdi管ovasculNVaoramusietiang+恶心和
Range of recovery 恢复的范围
Organ Function 器官功能
Expectation Time时间 期望值 Range范围
Can anaesthetics cause harm? 麻醉是有害的吗？
Bianchi SL, Tran T, Liu C et al. Brain and behavior changes in 12-month-old Tg2576 and nontransgenic mice exposed to anesthetics. Neurobiol Aging 2007. Culley DJ, Yukhananov RY, Xie Z et al. Altered hippocampal gene expression 2 days after general anesthesia in rats. Eur J Pharmacol 2006;549:71-8.
? agitation躁动 ? disorientation定向障碍 ? postoperative cognitive dysfunction (POCD)术后认知功
能障碍 ? sometimes prolonged hypotension有时发生长时间的低
血压 ? cases of good versus bad recovery患者恢复有好有坏
and vasodilation with propofol
but not with sevoflurane or desflurane in rabbits. Anesthesiology 2008;108:87-93
Example- effect on MAP 举例 – 对平均动脉压的影响
Concept of organ protection 器官保护的概念
Are all anaesthetics all equal? 所有的麻醉药都一样吗？
Harm 伤害
Protection 保护
We should not assume that all anaesthetics are equal, nor
should we assume that all drugs from the same class are the same既不能假设所有的麻醉药是一样的，也不应该假
done to the patients? 实施麻醉时您是否坚信在停药后 麻醉药物的影响是否可以完全逆
转而对病人没有伤害？
If you said yes… then why do we get……… 如果你的回答是“YES”，那么为什么我
们还会遇到……..
? prolonged nausea and vomiting 术后长时间的恶心和呕 吐
? Requires a potential organ injury存在潜在 的器官损害因素
What we don't know- what is the trigger for harm 我们不知道的 – 导致伤害的诱因
是什么？
? Drug药物 ? Dose剂量 ? Depth麻醉深度 ? Duration用药时间 ? Repeated exposure反复用药 ? Patient susceptibility病人的易感性 ? Importance of co-morbidities并存疾病的重要性 ? Are all anaesthetics equal???所有的麻醉药都一样吗？