吸入麻醉培训讲学.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：;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; ;; ;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  trachea)、麻醉机失灵(malfunction of  anesthesia apparatus ); 听诊： 心音强弱，心脏节律 Cardiac sound and rhythm 量： Blood pressure, peripheral pulse, urine volume MAP、CVP、PAWP、CO ECG：观察心律失常及心肌缺血 arrhythmia and myocardial ischemia Hypovol