胸科病人手术的麻醉.ppt

; 胸科手术的麻醉 遵义医学院麻醉学教研室　朱昭琼;要 求;第一节 剖胸及侧卧位时对呼吸、  循环的影响(p 119);剖胸及侧卧位时对呼吸、循环的影响;侧卧位对呼吸生理的影响;其次节　麻醉前评估与筹备;Preoperative evaluation ;????In patients with tracheal stenosis（狭窄）, the history should focus on symptoms or signs of positional dyspnea, static versus dynamic airway collapse, and evidence of hypoxemia. The history may also suggest the probable location of the lesion. Arterial blood gas (ABG) determinations may help to clarify the severity of underlying pulmonary disease but are not routinely necessary. Pulmonary function tests are useful in assessing the pulmonary risk of lung resection. Both exercise function (maximal oxygen uptake [O2max]) and spirometry (forced expiratory volume in 1 second) have been used to stratify risks of resection. In marginal cases, split-function radionuclide scans and ventilation/perfusion ( ) scans can determine the relative contribution of each lung and individual lung regions. ;?Cardiac function should be assessed if there is question of the relative contribution of cardiac and pulmonary disease in the patients functional impairment. Echocardiography can estimate pulmonary artery pressure and right ventricular function. Imaging studies, such as chest radiography, computed tomography (CT), and magnetic resonance imaging, are useful to determine the presence of tracheal deviation, the location of pulmonary infiltrates, effusion or pneumothorax, and the involvement of adjacent structures in the disease. ;Tracheal tomography or three-dimenional reconstruction from CT is used to assess the caliber of stenotic airways and can be used to predict the size and length of the endotracheal tube that will be appropriate for the patient. Severe airway stenosis（狭窄）observed preoperatively may change the anesthetists plans for induction and intubation. ;麻醉前评估; 肺功能测定;;;血气分析;?? Preoperative sedation should be given carefully to patients with tracheal or pulmonary disease. 1.Heavy sedation may impair postopera