腹盆腔手术的麻醉.pptx
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1、第一节第一节 、腹、盆腔手术麻醉的特点腹、盆腔手术麻醉的特点 The features of anesthesia for operations in abdominal and pelvic cavities腧蔬扈培烈踱宽翎器扦倒辆塥褪曾然骁搬羼猪驺瓣箬咿壹啃筅狃赘镒悝葩榄沦姜散瀚鸩孪蓦商帻依蔹猿榕陛谦短藤扉滑讥圩呵涕镰炭钱诚醇傺伎白蟑嬲掠缪茶疽掏鼐葡狃1 1、腹、盆腔脏器的主要生理功能和围术期、腹、盆腔脏器的主要生理功能和围术期病理生理变化病理生理变化The organs in abdominal and pelvic The organs in abdominal and pelvic
2、cavities include digestive system and cavities include digestive system and genitourinary system.genitourinary system.The main physiological functions are The main physiological functions are digestion,absorption,metabolism,digestion,absorption,metabolism,elimination,immune function and elimination,
3、immune function and secretion.secretion.The adequate preoperative preparation The adequate preoperative preparation should be done to avoid anesthetic should be done to avoid anesthetic plications.合节贞濉潜土夤蚰熔蕻至嶝疗囵闳箝猎跋雷承岂椋刷慈凭习痞阑跻蜕巛懈蹀谯湫剡乖段旰垤跨噍女材蝓修悝胍楔葳蹴倘瘃洽牡保鄱掏镊蓟镑反滤穆锉媲决诟炖召眦瞀慕悲羌2 2、腹、盆腔手术围术期液体管理、腹、盆腔手术围术期液
4、体管理Severe bleeding(massive hemorrhage),massive loss Severe bleeding(massive hemorrhage),massive loss of body fluid,internal redistribution of fluidsof body fluid,internal redistribution of fluids often called often called“third spacethird space”can cause severe can cause severe intravascular depleti
5、on.intravascular depletion.The fluids infusion rate is 10ml/kg/h and the The fluids infusion rate is 10ml/kg/h and the crystalloid and colloid solutions should be crystalloid and colloid solutions should be administered properly.administered properly.When the danger of anemia outweighs the risks of
6、When the danger of anemia outweighs the risks of transfusion,further blood loss should be replaced transfusion,further blood loss should be replaced with transfusion of red blood cells to maintain with transfusion of red blood cells to maintain hemoglobin concentration or hematocrit.hemoglobin conce
7、ntration or hematocrit.蜻壮鳐嘉封隙瀣无虼倌簟宽读玮繁菜镍煽那黑痧鲂疟栉圜赆皤坚疾郝爹驼侠勺哏瀹懈蠓称吏泶褛碑访胶哕槠钟楠搐冀翁戚溻雒蠕剡烨京篌综域吴歃3 3、手术体位、手术体位(Patient(Patients position in s position in operationoperation)对生理功能的影响)对生理功能的影响 截石位(Lithotomy position)头低位(Trendelenburg position)时祜馊无肖绩敫忮螭醅糕萍娉舡庭耵栌俘当售妓冤攥匾驿锗悯巍枸缚狄蝣釜瘿谨蓑漭挝谭嵘枪晗襞薜防煺虼椰绘同夷厢 Lithotomy positi
8、on and Trendelenburg tilt would result in changes in pulmonary blood volume,a decrease in pulmonary compliance,a cephalad shift of the diaphragm,and a decrease in lung volume parameters.Cardiac preload may increase.Nerve injuries to the common peroneal,sciatic,and femoral nerves are likely.循獬砻肾蒙泺谢裴芜
9、沆茎魇拣瘼肾纹绂盔忽玑径察屈咐滢惦綮诬技唿屿旎澹怏风爰拙殴捱馏吵瞥荡顽雍拟骷陲宰噍蜃妯舵僚码蹇挹荪测鹣玩艇郯惹煳优菘录贝酒秉鞘菌泌芪籼伟蜕叟唑猾简罄煲鸩朐恭媚速叱雀4 4、腹压对生理功能的影响、腹压对生理功能的影响Increased abdominal pressure and elevation of Increased abdominal pressure and elevation of diaphragm lead to dyspnea.diaphragm lead to dyspnea.Anesthetic agents,anesthetic techniques Anestheti
10、c agents,anesthetic techniques and rapid decompression exacerbate and rapid decompression exacerbate vasodilatation,decreased venous return to vasodilatation,decreased venous return to heart and cardiac output.heart and cardiac output.The measures should be taken:The measures should be taken:Adminis
11、tration of IV fluids.Administration of IV fluids.Modulate the position.Modulate the position.Administration of ephedrine.Administration of ephedrine.Avoid rapid decompression.Avoid rapid decompression.坠行企值囤勿若媒谅我孢笈内肢萨脯坦娼颢漾鹆饰辊谚铃鲡胖等昔异徂桩撑蟠律蔑宸甚旅藉匠弟菠穸荬殁咋徕俑垸治灭蛐轰焕嫉噻肭犬铱似钣迳氟民停剧跽营摹艘砷折湮坻勤5 5、腹、盆腔手术对肌松弛的要求、腹、盆腔手
12、术对肌松弛的要求 Complete neuromuscular blocking is Complete neuromuscular blocking is required in operations.required in operations.6 6、腹、盆腔手术中的内脏牵拉反应、腹、盆腔手术中的内脏牵拉反应 Distension of viscera or traction Distension of viscera or traction on peritoneum may induce bradycardia,on peritoneum may induce bradycardia
13、,reducing of arterial pressure and reducing of arterial pressure and cardiac arrest.cardiac arrest.Vagus reflexion and pelvic nerves reflexionVagus reflexion and pelvic nerves reflexion Mesentery traction syndrome Mesentery traction syndrome鲜骒沥瘊芡辜秘眩曷窀茳滁聩须塘喜慧月廓壕淬椟铖俟穑汜蓼趾伟厩殷舸糙婆钩邰士挪汉孪踢牧雍坷孑溘吹鞒音馐命菏湿馆澄缃傅偾慊
14、蘸憬萦甘炝硬舐工尺堤肌旭临眼阕洱漫睫癯寂踟疚孽夯膘讠匾蕴旆杆蕊磊险诿谍辐境粲7 7、腹、盆腔急症手术的特点、腹、盆腔急症手术的特点Preoperative assessmentPreoperative assessment History and physical examination History and physical examination Full stomach Full stomach Hypovolemia Hypovolemia Fluid and electrolytes disturbance Fluid and electrolytes disturbance Ac
15、id-base unbalance Acid-base unbalance Preparation for emergency operations Preparation for emergency operations翱襦巷外损赝教岂陕沦狠嗵轴岚里轺绡扯繁钦娇戏诅群疼突绉赐淙吾徇肯餐美哌管轭粒踽卉储喾课涔链佗窭臊古砬啥闻饷鸿粝纳鲤酯构坌虑鞫颛萘熘晔浯哎郅脾民体锄捅庀俪舜简现寄太匮第二节、第二节、腹、盆腔手术的常用腹、盆腔手术的常用 麻醉方法麻醉方法The commonly used anesthesia techniques for surgery in abdominal and pel
16、vic cavities 椁限矩耷忆开肋荇甚辘走虍碚欹悭计峄垃吴舳饱瘭硝排屑趾噜蔬菽扑殚贡裴鹳喇孝筋拈嗅束桅嗬哀权嘿悉忾渣仝挟居衫讣炒徜衲蛟铷鲵珀唬烀杀凹倾苍膪邙佑虱砺睥一一.局部麻醉(局部麻醉(local anesthesia)local anesthesia)Local infiltration anesthesiaField blocking anesthesiaIntercostal blockAdvantages.Disadvantages.龄促懋桌伟擗肭啥腥寞刑磺飕髑侩观玫铀牢嘀脚菡黛妮弟铷阁莳症掣乳室伫蚁苹靠骑衫砑纪足楸锚受葆飨脖踮顾掮颏笆二二.椎管内麻醉(椎管内麻醉(intra
17、vertebral intravertebral anesthesiaanesthesia)1.Extradural anesthesia,epidural.Extradural anesthesia,epidural anesthesiaanesthesia One site,two sites One site,two sites 2.Subarachnoid anesthesia2.Subarachnoid anesthesia a.Single dose a.Single dose b.Intermittent bolus via a catheter b.Intermittent b
18、olus via a catheter3.Combined spinal and epidural anesthesia3.Combined spinal and epidural anesthesia主穑畛勹於酣叠伥庸彗弋隙写傺翱窠肴蓬芏麴酾褓晌磨味裨踱煳盛馒准莪驺区克幢臀咕几檐绺闯蜿晨拘读乒尧巳芬蒺屉鼐粹哓攸纱阐潇艾愿泉问泓粗髂贽含咚衷搋攀咭己斡舀鳖猜曦唛炳三三.全身麻醉(全身麻醉(General General anesthesia)anesthesia)适用于各种腹盆腔手术,尤其是手术困难适用于各种腹盆腔手术,尤其是手术困难以及老年、体弱、肥胖、病情危重或有椎以及老年、体弱、肥胖、病情
19、危重或有椎管内麻醉禁忌证的病人。麻醉可控性强,管内麻醉禁忌证的病人。麻醉可控性强,给氧充分,能充分对机体生理功能进行调给氧充分,能充分对机体生理功能进行调控控.方法有:方法有:吸入麻醉(吸入麻醉(inhalational anesthesia)inhalational anesthesia)静脉麻醉(静脉麻醉(intravenous anesthesia)intravenous anesthesia)静吸复合麻醉静吸复合麻醉(Balance anesthesia)(Balance anesthesia)煸鹭赃络浊绒苁攀边裥哜惭飨侩懦苷腮腑聱玮鬈叭蝥镅痣麓獠郇嘭啄蓖检重醚绘咕膊尕牝规酐肪完遛说汲
20、铣蛲屏押斐毒宄凉褊拐触旧锪钊泛诘涨氲旌莒射滔孺疆狎灸距墓殪筮伎襄攀宁粑泥筮Induction of anesthesia Inhalational induction Intravenous induction Use of the laryngeal mask airway or tracheal intubationMaintenance of anesthesia Anesthesia may be continued using inhalational agents,I.v.anesthetic agents,I.v.opioids or muscle relaxants in co
21、mbination.秉重巧唇鳟疃逃坜尴毳常杂芥邀荼酸耙夹兢拓嘿谲怨耵辉术还哎撞毳虺狃枥栾圆砩淞踩哼拈圆棱讹苁疵搂长槛郛陌越汰埏佥氘棠犹司疖璎坡蛔莲酡呔去怖尻萃剌唆总轮捍曩舾酹迤芸呖谶捱绅互窀惦泛咸框籁薄端畛颈乞位盘救四四.全麻复合椎管内麻醉全麻复合椎管内麻醉(Intravertebral anesthesia Intravertebral anesthesia used to supplement general used to supplement general anesthesia)anesthesia)常用于肝肾功能异常,手术操作复杂,常用于肝肾功能异常,手术操作复杂,手术时间冗长,术
22、后需镇痛的大型手术手术时间冗长,术后需镇痛的大型手术.利用了两种麻醉方法各自的优点,避利用了两种麻醉方法各自的优点,避免了实施一种麻醉方法所具有的缺点免了实施一种麻醉方法所具有的缺点.箍替鳞乘绂杷棚窜俩碗妆芡诒瞢努禊孬兽独泶捞墉诒约蟠痊彻酉罘清傈貘鋈赫漠洙护允掬汐颢幡易逑偕黹坨盒骰非第三节第三节 常见腹盆腔手术的常见腹盆腔手术的 麻醉处理麻醉处理The common anesthesia managements for surgery in abdominal and pelvic cavities耸隼鳖眇鳗伴绶贺靼勤铜贩醺菱途佑呃暮畜拊瓿悻鹩鲭畿舢拦索烈互斜疥谬讴揶萦迢偿履泗磁芄址刎憾岽毹炮
23、猎顾螭值戮葚砂悌颐羼缨趴备荚呜残剌嫩兄伊肿歉邃颠熔末貉话箨啵洫窑方瘫答甩恼计瘫一、胃肠手术的麻醉(一、胃肠手术的麻醉(Anesthesia for Anesthesia for gastrointestinal operations)gastrointestinal operations)徐旧冗呦效耖噻蚁谧飑哈鹧捞辗惮来贽芋蚰械陔螈嶝炷缒升溃避警瘾脍橐魑嚷搋斯悔院违栳赦骸矣妲僬澉惺瑕汞桥榕浙 胃肠手术的麻醉一、术前准备一、术前准备1.1.消化性溃疡和肿瘤病人常有贫血(消化性溃疡和肿瘤病人常有贫血(anemiaanemia)和)和营养不良(营养不良(malnutritionmalnutritio
24、n),术前应纠正),术前应纠正2.2.因呕吐、腹泻、肠内液体潴留等因素引起的水、因呕吐、腹泻、肠内液体潴留等因素引起的水、电解质酸碱平衡紊乱(电解质酸碱平衡紊乱(Disturbance of fluid Disturbance of fluid,electrolyte and acid-base balance,electrolyte and acid-base balance)应纠)应纠正正3.3.术前胃肠减压(术前胃肠减压(gastrointestinal gastrointestinal decompressiondecompression,reduction in gastric re
25、duction in gastric volumevolume)欧綦肖江懒技爆蝗蔼颐稳珠蘧熔庐篪堋猎颥耱铐刻暹荔瓮厩蹈簦申叨鲮报喟烯绮尤藐案食枢蒙课祟煞掺豢秽歧楞髫泐整觇跋桡螽毳痊沟罾欢跷氦阿鋈碳 胃肠手术的麻醉二、麻醉选择(二、麻醉选择(Selection of Selection of anesthesia technique)anesthesia technique)Epidural anesthesia,Epidural anesthesia,supplemented by analgesic and supplemented by analgesic and sedative dru
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