腹盆腔手到术麻醉.ppt

第二十一章 腹、盆腔手术的麻醉Chapter 21 Anesthesia for operations in abdominal and pelvic cavities 第一节 、 腹、盆腔手术麻醉的特点 The features of anesthesia for operations in abdominal and pelvic cavities 1、腹、盆腔脏器的主要生理功能和围术期病理生理变化 The organs in abdominal and pelvic cavities include digestive system and genitourinary system. The main physiological functions are digestion, absorption,metabolism, elimination, immune function and secretion. The adequate preoperative preparation should be done to avoid anesthetic complications. 2、腹、盆腔手术围术期液体管理 Severe bleeding(massive hemorrhage), massive loss of body fluid,internal redistribution of fluids— often called “third space” can cause severe intravascular depletion. The fluids infusion rate is 10ml/kg/h and the crystalloid and colloid solutions should be administered properly. When the danger of anemia outweighs the risks of transfusion, further blood loss should be replaced with transfusion of red blood cells to maintain hemoglobin concentration or hematocrit. 3、手术体位(Patient’s position in operation）对生理功能的影响 截石位（Lithotomy position） Lithotomy position and Trendelenburg tilt would result in changes in pulmonary blood volume, a decrease in pulmonary compliance, a cephalad shift of the diaphragm, and a decrease in lung volume parameters. Cardiac preload may increase. Nerve injuries to the common peroneal, sciatic, and femoral nerves are likely. 4、腹压对生理功能的影响 Increased abdominal pressure and elevation of diaphragm lead to dyspnea. Anesthetic agents,anesthetic techniques and rapid decompression exacerbate vasodilatation, decreased venous return to heart and cardiac output. The measures should be taken: Administration of IV fluids. Modulate the position. Administration of ephedrine. Avoid rapid decompression. 5、腹、盆腔手术对肌松弛的要求 Complete neuromuscular blocking is required in operations. 6、腹、盆腔手术中的内脏牵拉反应 Distension of viscera or traction on periton