医学PPT课麻醉快速程序诱导RapidSequence .ppt

快速程序诱导 Rapid Sequence Induction 南京市第一医院 鲍红光 病 例（Case Insert） A 38 year old female，女性 38岁 Peritonitis for 3 days 腹膜炎3天 Shocked with: 休克： 1. T: 38 o C 体温：38℃ 2. Pulse:120/minute 脉搏：120次/分 3. BP: 70 mmHg systolic 血压：收缩压 70mmHg 4. Poor nail bed capillary return 末？回流差 5. Respiratory rate 呼吸：30次/分 6. Confused 烦躁 7. Urinary: 20mL of concentrated urine 尿量: 20mL 的浓缩尿 The surgeon wants to operate immediately 外科医生准备尽快手术 麻醉方式？Anesthesia ? regional anesthesia? 硬膜外麻醉？ General anesthesia?全身麻醉？ 诱 导Induction 芬太尼 Fentanyl 异丙酚 Propofol 罗库溴胺 Rocuronium 快速诱导插管 RSI 快速顺序插管Rapid Sequence Intubation 病 例（Cases） 成年病人（Adult patient） 小孩（Child） 全身麻醉的主要并发症Main complications of GA ? Regurgitation 返流 ? Vomiting 呕吐 ? Aspiration 误吸 快速诱导插管的目的GOAL of RSI 保护气道 Protect airway 便于插管 Facilitate intubations 快速诱导麻醉 Rapidly induce anesthesia History Cricoid cartilage pressure to prevent regurgitation- Sellick1961. First series of ED intubations –Taryle, 1979 First series of intubations using succinylcholine in the ED – Thompson, 1982 American College of Emergency Physicians (ACEP) RSI policy statement(1997):- Reaffirmed, 2000 “physicians performing RSI should possess training, knowledge, and experience in the techniques and pharmacologic agents used to perform RSI” Today （当 今 ） 1.RSI resides in the domain of emergency medicine practice 主要应用于急诊医学领域 2. Key in the successful management of the “A” of “ABCs 心肺复苏“ABC”中“A”的核心 3. Increases the chance of successful intubation and minimizes the risks 增加插管的成功率和减少风险 COMPLICATION:并发症: 15% aspiration误吸, 28% airway trauma气道损伤, 3% death死亡 – 1999 Li et.al. 美国国家急诊气道注册机构 National Emergency Airway Registry (NEAR) 适 应 症 (Indication) Full stomach“饱胃” (尤其是急诊手术或者剖腹产手术需要全身麻醉). Gastric content aspiration risk 胃内容物反流风险较大 (肥胖, 胃食管反流或者糖尿病） Contraindications禁 忌 症 The predicted difficult airway 预先判断有困难气道 Inexperience