脊柱侧弯--叶亚军.ppt

脊柱侧弯矫形术 麻醉处理 叶亚军 麻醉方法 术中体温的检测 围术期浅低温引起很多严重的并发症 心脏疾病，凝血功能障碍，增加输血, 降低药物代谢导致术后恢复延长。 通过降低多形粒细胞的氧化杀菌作用损害机体免疫功能，致使手术部位感染增加 300% 有关脊柱侧弯麻醉的文献 地氟醚血气分配系数低,诱导平稳快速,麻醉 深度易于控制较适合于唤醒实验,但唤醒期间血 流动力学波动明显,复合低剂量的麻醉性镇痛剂 芬太尼,可减轻苏醒期间的即发疼痛反应 病例 3 恶性高热 女性 24岁 病例 3 恶性高热 曾在上海长征医院就 诊。 病人自诉：麻醉后呼 末二氧化碳升高，取消 手术。 病例 3 恶性高热 病人呼末CO2升 高，一度达到60 mmhg 增加呼吸频率 20次/分 气道压力增高 病例 3 恶性高热 病例 3 恶性高热 取肌肉组织司可林浸泡 恶性高热 早期表现：呼末二氧化碳明显增高 体温增高 处理： 有效降温，体表，创口，血液 一般处理，更换呼吸管道，钠石灰， 激 素 恶性高热 Case 1 Case 1 was a 23.8-yr-old, 68-kg muscular woman with a personal history of one previous general anesthetic without unusual metabolic responses and a negative family medical history. She had no abnormalities of muscle tone or structure preoperatively and no cardiopulmonary disease. She was an elite athlete. She was anesthetized for a total thyroidectomy and radical neck dissection for thyroid cancer. Case 1 Her second general endotracheal anesthetic included isoflurane and succinylcholine. Anesthetic monitoring before the signs of MH included capnometry, pulse oximetry, and an esophageal temperature probe. Four hours 33 min after an anesthetic induction, she developed tachycardia. She subsequently developed (in order of appearance) arrhythmia, rapidly increasing temperature (maximum temperature 41.0°C), generalized muscular rigidity, hypercarbia, and excessive bleeding. Case 1 Results of an arterial blood gas drawn 4 h 45 min after anesthetic induction while the patient was being hyperventilated with a Fio of 1 were a pH of 6.78, a Pco2 of 147 mmHg, a Po2 of 250 mmHg, a base excess of -17 mEq/l, and a bicarbonate level of 20 mEq/l. Peak potassium was 6.9 mEq/l, peak creatine kinase was 9,205 U/l, prothrombin time was 28 s (upper limit of normal, 17 s), and partial thr