臨床麻醉學(xué)課件

單擊此處編輯母版標(biāo)題樣式,,單擊此處編輯母版文本樣式,,第二級(jí),,第三級(jí),,第四級(jí),,第五級(jí),,臨床麻醉學(xué)〔Clinical Anesthesiology〕緒論〔Introduction〕,The term “anesthesia〞( 麻醉) is derived from Greek Word, it means “l(fā)ack of feeling or sensation 〞 or“privation of senses 〞 im plying,,lack of appreciation. The usual concept for anesthesia relates primarily to the prevention of pain perception during an operation or an invasive procedure . But , this concept is out of date now.,,In general , anesthesia can be defined as a drug-induced or physical factors-induced state of reversible functional depression of part of the central nervous system or peripheral nervous system,which is characterized by loss of sensation ,especially pain perception .,,,The increasing complex nature of operations sparked the development of anesthesia . Advance in related basic science especially in research in anesthesia per se ,and the development of new agents ,adjuvants , eguipments, technigues and capacity of sustaining life had changed and broadened anesthesia into a discipline concerned with more than relief of pain . over the past 5~6 decades ,anesthesiology(麻醉學(xué)) has emerged as a clearly defined specialty and firmly established .,,The evolution of modern anesthesiology may be devided into 3 stages : 1、麻醉〔anesthesia〕 2、臨床麻醉學(xué)(Clinical anesthesiology) 3、麻醉與危重病醫(yī)學(xué)(anesthesiology and critical care medicine) department of anesthesiology and resuscitation  department of anesthesiology and critical care medicine .,,,一、麻醉學(xué)開展簡史,,(The history of anesthesia ),,,1、Ancient times,,〔1〕Acupuncture analgesia >475~221 B.C.,,〔2〕華陀(141~203 )麻沸散,,〔3〕Ancient Egyptians used The combination of opium poppy and hyoscyamus,,〔4〕The Incas may be the earliest to use local anesthesia .,,2、Modern anesthesiology,,〔1〕Inhalational Anesthesia (吸入麻醉),,1844 Horace wells N2 0 (氧化亞氮),,△ 1846 William T.G. Morton Ether (乙醚),,1847 James Simpson chloroform(氯仿),,△ 1920 Arthur E. Guedel was the first to elaborate,,on the signs of general anesthesia,,△ Magill Endotracheal intubation (氣管內(nèi)插管),,△1927 Ralph waters sodalime (鈉石灰),,1956 halothane (氟烷),,1972 enflurane (恩氟烷),,1981 isoflurane (異氟烷),,1990 sevoflurane (七氟烷),,1992 desflurane (地氟烷),,〔2〕Intravenous anesthesia (靜脈麻醉),,·1934 Lundy 和waters thiopental (硫噴妥鈉),,· benzodiazepines ( 苯二氮卓類藥 ),,diazepam 〔地西泮〕 1959,,midazolam (咪達(dá)唑侖) 1976,,· others:,,sodium hydroxybutyrate , r-oH (羥丁酸鈉)1960,,ketamine (氯胺酮) 1970,,etomidate (依托咪酯) 1972,,△propofol (丙泊酚) 1983,,(3) opioids,,△ fentanyl (芬太尼),,sufentanil (舒芬太尼),,alfentanil (阿芬太尼),,△ remifentanil (瑞芬太尼),,(4) Muscle Relaxants (肌肉松弛藥),,△,1942 curare (箭毒),,Succinylcholine (琥珀膽緘),,Mivacurium (米庫氯銨),,Now , the relaxants in common use include,,,Vecuronium (維庫溴銨), atracurium (阿屈庫銨),,Rocuronium (羅庫溴銨),,Cisatracuronium (順式阿屈庫銨),,〔5〕Local and Regional anesthesia (局麻和區(qū)域麻醉),,1884 Carl koller topical cocaine (可卡因表麻),,1898 August Bier spinal anesthesia (脊麻、腰麻),,1901 Ferdinand cathelin and Jean sicard caudal epidural anesthesia (骶麻),,1921 Fidal pages and 1931 Achille Dogliotti Lumbar epidural anesthesia (腰部硬膜外麻醉),,1904 Alfred Einhorn synthesized procaine,,Other local anesthetics:,,dibucaine(地布卡因，1930)，tetracaine(丁卡因 1932),,lidocaine(利多卡因，1932)，chloroprocaine(,氯普魯卡因,,1955),,mepivacaine(甲哌卡因,1957),prilocaine(丙胺卡因,1960),,bupivacaine(布比卡因 ,1963),etidocaine(依替卡因,1972),,,△,The latest local anesthetics include ropivacaine(羅哌卡,,因)and levobupivacaine(左旋布比卡因),,,△Anesthesiologist prof Rovenstine,,established the first pain clinic,,△1970 In USA, society of critical care,,medicine formed(美國危重病學(xué)會(huì)成立 ),,(6)Since the eighties of last century until now the clinical anesthesiology is characterized by emphasizing anesthetic monitoring and paying more attention to anesthetic safety.,,The minimum standards for intraoperative monitoring have been adopted by the ASA (American society of Anesthesiologists) include:,,Body temperature(體溫 ),,Arterial blood pressure and heart rate,,Electrocardiography (ECG) (心電圖),,Pulse oximetry (S,P,O,2,，脈搏氧飽和度),,End tidal carbon dioxide (呼氣末二氧化碳),,For other monitoring methods, you may choose it when it is necessary.,,二．麻醉學(xué)專業(yè)的任務(wù)和范圍,(The scope and task of Anesthesiology),The scope and basic tasks of anesthesiology include:,,1.Clinical anesthesiology,,(1).To perform preanesthetic visit and evalualion , and to formulate anesthetic plan. Taking part in the preanesthelic preparation.,,(2).To render patients insensible to pain and discomfort and keep the stress response at suitable level.,,(3).To monitor the patients during operations,and to regulate or control the importaut physiological functions of the patients in order to provide maximum safety for the patients and to provide optimal operative conditions for surgeons.,,(4).To prevent and treat anesthetic complications,,(5).To monitor and treat patients in postanesthesia care unit (PACU),,2.First aid and resuscitation(急救與復(fù)蘇),,3.Critical care medicine (CCM,危重病醫(yī)學(xué)),,(intensive care medicine,也稱加強(qiáng)醫(yī)學(xué)),,Its clinical position is called Intensive care unit, ICU (重癥監(jiān)測治療病室或加強(qiáng)醫(yī)療病室),,4.Pain management and its relatcd researeh epically the mechanism of pain,,5.Research ,teaching and training,,三．如何學(xué)好麻醉學(xué),(How to learn anesthesiology),1.To combine basic medical sciences with clinical medicine(根底與臨床結(jié)合),,2.To combine theory with practice (理論與實(shí)踐結(jié)合),,Anesthesiologist on paper; craftsman of anesthesia,,3.To learn, to investigate continuously; and to make progress continuously.,,四．麻醉的分類,(classifications of anesthesia),1.classification of anesthetic technigues,,(按麻醉方法分類),,In a broad sense all types of anesthesia may be classified as either regional or general. But, in China, because of the wide usage and characteristic theoritical basis of epidural and spinal anesthesia, they are put into an independent class called “intravertebral anesthesia〞.,,Anesthetic technigue may be classified as follows:,General,,anesthesia(全身麻醉),,.inhalational anesthesia (吸入麻醉),,.intravenous anesthesia (靜脈麻醉),,.intramuscular anesthesia (肌肉麻醉),,.rectal anesthesia (直腸麻醉),,,,,,Lntravertebral anesthesia (椎管內(nèi)麻醉),,.subarachnoid block (蛛網(wǎng)膜下隙阻滯),,(spinal anesthesia,脊麻.腰麻),,epidural block (硬脊膜外隙阻滯),,Some times subarachnoid block and epidural block are,,also called “neuraxial anesthesia〞(神經(jīng)軸麻醉),,Local anesthesia (局部麻醉),,·topical anesthesia (外表麻醉),,·local infiltration (局部浸潤麻醉),,·field block ［區(qū)域〔術(shù)野〕阻滯］,,(peripheral) nerve blocks (周圍神經(jīng)阻滯,神經(jīng)阻滯),,intravenous regional anesthesia (靜脈局部麻醉),,In some textbooks and monographs, nerve blocks, spinal,,anesthesia and epidural anesthesia are collectively called,,“regional blook〞 or “regional anesthesia〞,,Everyday expressions or terms in common use;,balanced anesthesia (復(fù)合麻醉),,combined anesthesia (聯(lián)合麻醉),,basal narcosis (根底麻醉〕,,endotracheal anesthesia (氣管內(nèi)麻醉),,endotracheal intubation (氣管內(nèi)麻醉),,endoBronchial anesthesia (支氣管內(nèi)麻醉),,2.1 classifications according to the subspecialty of clinical anesthesiology (接臨床麻醉亞學(xué)科分類) such as:.,,anesthesia for cardiac surgery (心臟手術(shù)麻醉),,anesthesia for Vascular surgery (血管外科手術(shù)麻醉),,anesthesia for thoracic surgery (胸科手術(shù)麻醉),,neurosurgical anesthesia (顱腦外科麻醉),,anesthesia for organ transplantation,,(器官移植手術(shù)麻醉),,anesthesia for endocrine surgery(內(nèi)分泌外科麻醉),,obstetric anesthesia (產(chǎn)科麻醉),,pediatric anesthesia (小兒麻醉),,geriatric anesthesia (老年人麻醉),,anesthesia for orthopedic surgery (骨科麻醉),,anesthesia for abdominal sugery (,腹部外科麻醉,),,anesthesia for trauma (,創(chuàng)傷外科麻醉,),,and so on,,,2.2 classifcalions according to the subspecialty of anesthesiology (,按麻醉學(xué)的亞學(xué)科分類,),,clinical anesthesiology,,critical care medicine,,pain management,,。