3 monitoring 麻醉监测.ppt

Monitoring Sanqing Jin, pH.D., M.D., Department of Anesthesia, Sixth Affiliated Hospital， Sun Yat-sen University 中山大学附属第六医院麻醉科 靳三庆 博士 博士生导师 I. Standard monitoring A．Standard monitoring for general anesthesia involves oxygenation, ventilation, circulation, and temperature. B．Standard monitoring for monitored anesthesia care and regional anesthesia involves oxygenation, ventilation, circulation, and temperature. C．Additional monitoring. II. Cardiovascular system A．Circulation 1．Flow to organs is directly related to pressure gradient and inversely related to vascular resistance. 2．Pressure gradient can be estimated by the difference between mean arterial pressure (MAP) and venous pressure, or, for the cerebral circulation in the case of increased intracerebral pressure (ICP), the difference between MAP and ICP. A．Circulation 3. Signs and symptoms of perfusion abnormalities a. Central nervous system: mental status changes, neurologic deficits. b. Cardiovascular system: chest pain, shortness of breath, ECG abnormalities, wall motion abnormalities. c. Renal: decreased urine output, elevated BUN and creatinine, decreased fractional excretion of sodium. d. Gastrointestinal: abdominal pain, decreased bowel sounds, hematochezia. e. Peripheral: cool limbs, poor capillary refill, diminished pulses. B. ECG 1. Mechanism of monitoring a. Electrode pads. b. Electrode locations. c. Modes and options ⑴ Monitors often have several choices for filtering of noise, most commonly called “diagnostic”and “monitor” modes. The diagnostic mode should be used when monitoring for ischemia. ⑵ Automatic trending of ST segment changes is often available and useful for monitoring the development of ischemia over time. B. ECG 2. Rhythm detection.. 3. Ischemia detection. Monitoring leads II and V5 allows for detection of ischemia anywhere in a large area of the myocardium. Lead II monitors the inferior portion of the heart, supplied by the right coronary artery. Lead V5 monitors the bulk of the