第26章 妇产科手术的麻醉.pptVIP

主要内容 SCETION 1 妇科手术的麻醉 妇科手术麻醉的特点 妇科麻醉的选择 常见妇科手术的麻醉 SECTION 2 产科手术的麻醉 产科麻醉的特点 麻醉药对母体和胎儿的影响 胎盘屏障对麻醉药的影响 产科手术的麻醉 新生儿窒息与急救 The characters of anesthesia for gynecologic procedures 完善的镇痛与肌松；特殊体位的影响及防护 Satisfactory analgesia and muscular relaxation; Trenderlenberg position and it’s effect. 中老年；合并症；贫血等；术前治疗与纠正 Middle and aged; Pre-exist diseases and abnormalities; Preoperative treatment and correction. 多为择期手术；术前充分准备 Most are selective and should be well prepared. Choice of anesthesia 椎管内阻滞麻醉（硬膜外麻醉和腰麻） Epidural block(EA) and spinal anesthesia(SA) EA分为一点、两点穿刺法和联合阻滞(spinal-epidural combined anesthesia)；经腹手术麻醉平面应达T6-8；子宫全切及经阴道手术还需阻滞骶从神经。 全身麻醉 General anesthesia(GA) 主要用于有椎管内麻醉禁忌者。 The anesthesia for common gynecologic procedures 子宫及附件切除术 hysterotomy and salpingo-oophorrectomy 年龄较大；合并症多；慢性贫血突出； 应作好术前准备； 常选用硬膜外麻醉；必要时全麻； 宫颈癌根治术范围广、创伤大、时间长，应注意术中监测和体液平衡的管理。 The Characters of obstetric anesthesia EFFECTS OF ANSTHETICS ON PARTURIENT AND FETUS 麻醉性镇痛药 非阿片类中枢性镇痛药 非巴比妥类镇静安定药 巴比妥类镇静药 局部麻醉药 全身麻醉药 肌肉松弛药 Almost all narcotic anesthetics are easily to pass through placenta and therefore inhibit fetus. 吗啡 morphine 哌替啶 pethidine 芬太尼 fentanyl 阿芬太尼 alfentanil 舒芬太尼 sufentanil 瑞芬太尼 remifentanil 曲马多(tramal) 能透过胎盘，但治疗量很少抑制宫缩和胎儿（新生儿）呼吸。可安全用于产科麻醉和镇痛。 It’s a non-opioid central analgesic. It can also penetrates placenta, but rarely inhibits uterine contraction and neonatal respiration in theoretical dose. Therefore it’s safe for obstetric anesthesia and pain-relieving. Almost all non-barbital sedatives are easily to pass through placenta and therefore inhibit fetus. 安定 valume, diazepam 咪唑安定 midazolam 氯丙嗪 Chlorpromazine 异丙嗪 Promethazine 氟哌啶 droporidol Barbiturates 巴比妥类药物如硫喷妥钠、巴比妥钠等极易透过胎盘，可影响新生儿阿帕加评分及神经行为评分。慎用。已少用。 Barbiturates may rapidly appear in umbilical blood after use and may result in poor neonatal Apgar’s score and neurobehavioral score. Local anesthetics 1 影响透过胎盘速度的因素 蛋白结合度 protein-binding rate 分子量 molecular weight 脂质溶解度 lipid solubility 胎盘内降解 int