第25章小儿麻醉.ppt

小儿麻醉Pediatric Anesthesia 概 述（INTRODUCTION) 为小儿提供麻醉安全保障的基础在于完全地理解小儿在发育的生理学、药理学及心理学方面和成人的差别。 (The provision of safe anesthesia for the pediatric patient depends on a clear understanding of the physiologic, pharmacologic and psychologic differences between children and adults. ) 内容提要 小儿发育的生理学特点 小儿麻醉的药理学特点 麻醉前准备 麻醉管理 麻醉后处理 小儿发育的生理学特点DEVELOPMENTAL PHYSIOLOLGY OF THE CHILDREN 呼吸系统（Respiratory System) 气道的解剖学特点（Anatomy of the Airway ) 婴儿舌头相对于口咽腔大，增加了呼吸道梗阻的可能性以及喉镜显露声门时技术上的难度； (The relatively large size of the infant’s tongue in relation to the oropharynx increases the likelihood of airway obstruction and technical difficulties during laryngoscopy.) 呼吸系统（Respiratory System) 婴儿的喉头位置（C2）较成人（C4）高，使用直喉镜片较弯喉镜片更易显露声门； (The larynx is located higher in the neck, thus making straight blades more useful than curved blades.) 呼吸系统（Respiratory System) 会厌形态各异，粗短，且与喉入口呈一定角度，使用喉镜控制会厌显露声门存在一定困难。 (The epiglottis is shaped differently, being short and stubby, and is angled over the laryngeal inlet, control with the laryngoscope blade is therefore more difficult.) 呼吸系统（Respiratory System) 声带呈前倾角，盲探插管时气管导管易进入声门前联合而不易进入气管内； （The vocal cords are angled , so that a “blindly” passed endotracheal tube may easily lodge in the anterior commissure rather than slide into the trachea） 呼吸系统（Respiratory System) 婴儿的喉部呈漏斗状，最狭窄处在环状软骨水平；成人最狭窄部位在声门开口，气管导管通过声带后易进入气管内，而小儿最狭窄部位在环状软骨，气管导管易通过声门而不一定通过声门下,基于此10岁以下小儿最好选用无套囊导管。 （The infant larynx is funnel-shaped, the narrowest portion occurring at the cricoid cartilage. In the adult , an endotracheal tube that passes the vocal cords will readily pass into the trachea, because the glottic opening is the narrowest portion of the larynx. In the infant or young child, an endotracheal tube that easily passes the vocal cords may be tight in the subglottic region because of the narrowing at the cartilage. For this reason, uncuffed endotracheal tubes are the preferred choice for patients younger than 10 years of age ） 呼吸系统（Respiratory System) 呼吸系统（Respi