全麻下肢骨科手术中止血带反应处理.ppt

全麻下肢手术中止血带反应的处理 Evaluadon only. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  病历摘要 29岁男性,体重:61kg,身高:153cm ◎诊断:胫骨上端闭合性骨折 ◎择期全麻下:胫骨干骨折切开复位内回定术 o既往史:生长受限,多次骨折史 ASA邛级 ◎麻醉方式:全麻+神经阻滞 ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  术前检查 oHb 151g/dL, Hct 43.7%, Plt 194*109/L OALT 53U/L, AST 31U/L oG凵U3.6mmo∥L,UREA50mmo∥L,CREA60umol∥L oECG:窦性 o胸片:正常 ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  病例摘要 o09:00入室HR1122次/分,BP160/120mmHg,SpO299% o09:00-10:00力月西1mgⅳ,舒芬太尼5ugⅣv,坐骨神经阻滞, HR110120次/分,BP160175/100-120mmHg,SpO299% ◎10:00全麻诱导:异丙酚TcI4ug/ml,舒芬太尼20ugⅣ,顺式阿 曲库铵12mgⅣ,HR60次/分,BP160/120mmHg ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  术为式肚千骨折切开复位内固定术 前用内阿托 方式全坐骨神段阻滑 ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ◎术中高血压:血压升高超过麻醉前20%或血压升高达165/95mmHg °血压过高:血压升高超过麻醉前30mmHg °麻醉浅? o缺氧? ocO2蓄积早期? o甲状腺功能亢进、嗜铬细胞瘤? ◎术前精神高度紧张? ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  止血带 全身影响:心血管、呼吸、脑、体温、代谢 局部影响:神经、肌肉、皮肤 ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  全身影响一心血管系统 止血带充气 ◎循环血量+,全身血管阻力+→cvP+SBP+ o双下肢驱血:增加15%(约800m)血量 止血带充气30-60min OHR+ SBP +, Dbp TOurniquet Pain对镇痛药物不敏感,加深麻醉深度效果不明显 止血带放气 mo回心血量+缺血后反应性充血→cvP-,BP P C. A Kam,,et al. The arterial tourniquet: pathophysiological consequences and anaesthetic implications. Anaesthesia, 2001 ch Asposeslides for NET 4o dien