妇科麻醉并发症及风险课件.pptVIP

-- 术中子宫肌层注射垂体后叶素 -- 术中生命体征：BP↑，HR↓，余无特殊 ▲变化幅度 BP：150~160/100~110mmHg，HR55~65bpm ▲持续时间：30min左右 2 -- 患者出现面色青紫，眼睑闭合不全 -- 加深麻醉，NARCOTREND : F0 ~ D0 -- 血压很难通过麻醉深度的变化调整，DXM 10mg iv -- 术毕停止输注所有麻醉药物，潮气量及呼吸频率均达 到拔管条件， Narcotrend：B，拔出气管导管 ▲手术时间：2h；术中输液：1250ml；术毕尿量：200ml 3 可修改 欢迎下载 * 2021/4/26 -- 拔管后15分钟：患者意识仍未恢复，SpO2不升，最低77％（air），面罩正压通气，可达94％以上 -- Narcotrend ：D0 ；余生命体征平稳 -- 患者出现三凹征；听诊双肺：逐步出现湿啰音；进一步症状：口腔咯出粉红色泡沫痰，夹杂血丝 -- 诊断：肺水肿！ 4 体位？ 补液？ 垂体后叶素？ 麻醉技术？ 气腹？ 病因分析 抗利尿激素 缩宫素 垂体后叶素 Posterior Pituitary 家兔急性肺水肿模型建立 快速、大量输液 肾上腺素 家兔急性肺水肿模型建立 快速大量输液 血容量增加，回心血量增加 血浆胶体渗透压下降 肾上腺素 外周血管广泛收缩，血液由体循环急速转移到肺循环，左心房和肺毛细血管流体静压突然升高→肺间质肺水肿 血管通透性增大→肺泡肺水肿 上肢补液+体位静脉回流+抗利尿激素 肺水肿模型建立！！ 抗利尿激素 缩宫素 垂体后叶素 Posterior Pituitary Pulmonary edema possibly developing secondary to the intravenous administration of oxytocin A case of acute pulmonary edema possibly developing secondary to the administration of iv oxytocin Clinicians should be aware of the potential for pulmonary edema secondary to iv oxytocin Close hemodynamic monitoring should be done during oxytocin therapy Shahin J, Guharoy SR Vet Hum Toxicol, 1991 Acute?pulmonary oedema?following oxytocin administration: a life threatening complication A 26 years primigravida developed acute onset severe?pulmonary oedema?in postpartum period to whom oxytocin was infused for the induction of labour and to prevent postpartum haemorrhage Ghai B,?Vayjnath AM,?Lal S J Indian Med Assoc, 2006 Cardiovascular Toxicology, 2011 人工气腹影响循环呼吸系统 CO2 pneumoperitoneum results in ventilatory and respiratory changes Hemodynamic changes observed during laparoscopy result from the combined effects of pneumoperitoneum, patient position, anesthesia, and hypercapnia from the absorbed CO2 Reflex increases of vagal tone and arrhythmias can also develop Intro-abdominal pressure Arterial pressure Cardiac output Systemic vascular resistance Venous return Different mechanisms leading to decreased CO during pneumoperitoneum for laparos