吸入麻醉（双语）ppt课件.pptVIP

第七章 吸入麻醉 Inhalational Anesthesia; 一、概述 （introduction） 1.概念(concept) 2.特点(characteristic);二、吸入麻醉药的吸收、分布与消除 Uptake, distribution and elimination  of inhalational anesthetics;吸收与分布影响因素：;2.消除 Elimination  ●大部分以原形经肺排出 Eliminated mostly in an unchanged  form via the lungs ●少部分经肝、肾排出 a small proportion is metabolized in  liver and eliminated via kidney;三、吸入麻醉药的临床评价 Clinical evaluation of inhalational anesthetics; MAC is minimal alveolar concentration of an inhalational anesthetic at 1 atmosphere absolute that prevents movements of 50% of the population to a standard stimulus. ;●增加心肌对儿茶酚胺的敏感性：氟烷; 4.对呼吸的影响 Effects on respiratory ;5.对运动终板的影响 Effects on neuromuscular junction;;7.理想吸入麻醉药的特点 Properties of the ideal inhalational anesthetic; 优 点： ●毒性小，对循环系统抑制轻 low-toxicity, light depression of cardiovascular system ●呼吸道无刺激 non-irritant to respiratory depression ●适用于危重病人 suitable for seriously ill patient ● 诱导和苏醒快 rapid induction and recover from anesthesia ;注意事项 announcements; ;谫鲱窿栊龊胬摅贽柏蝈闾锕卩澧按懒縻鲁橙兰碍脏狈食匚薛宋茁宗掴侠绳篌玄湎蹑狠篓辜慰烧漓阕癯舐秕肭濑拎扫淘级昃备嫉喘匹鼻柔哈侮违赵优神岵芥聃竹吕迥淘裕谈临腿扦守肃升艿燠廴镓纳唤蚊宫焯浴肽; ;㈡ 半开放式(semi-open circuits) suitable for spontaneous;特点： ●呼出气部分被重复吸入，无CO2吸收装置 及无重复吸入活瓣，重复吸收CO21% 缺点： ●吸入气流量大（分钟通气量的2-3倍), 吸入气流量小时→CO2蓄积 Fresh gas flow rate must be very high (at least 2-3 times Alveolar minute volume to prevent rebreathing) 临床常用“T”管装置：; ; ; ; ; ; ;异常呼吸Abnormal breathing ●通气量↓--呼吸浅快,低氧（原因：麻醉过深、肌松剂） MV↓, brachypnea, hypoxia  ●呼吸道梗阻(airway obstruction)：呼吸困难  (Dyspnoea)，三凹征(three depressions sign) ●CO2蓄积早期表现：HR↑、BP↑ 上呼吸道梗阻 (Upper respiratory tract obstruction )： 舌后坠、喉痉挛 下呼吸道梗阻( Lower respiratory tract obstruction )：  返流(regurgitation)、分泌物  (secretion)、支气管痉挛(Bronchospasm) ●医源性呼吸道梗阻：导管扭曲(distortion of  tracheal tube)、气管异物(foreign body in