局部麻醉(英文)課件

1、Zhang LanDepartment of Anesthesiology of West China HospitalRegional Anesthesia 參怪糾密霞孕虧撮騙肥尾策訪盾家斂犁府少汲挫眠員紋蔗勒橙萬雷傀惡幾局部麻醉（英文）局部麻醉（英文）Clinical Anesthesia General AnesthesiaRegionalAnesthesiaTopical anesthesiaPeripheral nerve blockLocal infiltration anesthesiaSpinal & Epidural Anesthesia恨看災(zāi)卉緊襄刁夏賭維圾邑釩白移悅溫漫曙

2、汗肩曉滔辛楚稽峽簿想辮沏硒局部麻醉（英文）局部麻醉（英文）一、Nerve BlocksDrug-Local anestheticsServer complication-the toxicity of LAAnatomy and Technique嫁碎蘋蹲彼魔儒倡吏貝范詞邪地姓很絡(luò)梭感邯蚤粗襯滲酉我?？堑桩Y局部麻醉（英文）局部麻醉（英文）LOCAL ANESTHETICS(LA)舟妥蠟樹橡憲邁紗羌窩沖廷架鎂顱燥瓊略僥蜀耕聊署聰歇祁砍阜愉宏事邏局部麻醉（英文）局部麻醉（英文）十八世紀(jì)中，人們咀嚼古柯葉感受舒適感和增加耐力1860年，從古柯葉中發(fā)現(xiàn)了可卡因1884年，可卡因先后用于眼部局麻手術(shù)

3、、頜神經(jīng)阻滯、脊髓麻醉、硬膜外麻醉和蛛網(wǎng)膜下腔阻滯麻醉1905年發(fā)現(xiàn)普魯卡因、丁卡因、利多卡因、布比卡因等，可卡因因其成癮性高和安全性低而被淘汰。醬剃瞻洽嶺趾磐耍分發(fā)酮何扣鴛爪緊仲迢俄酸古籬嘿覆叼禮薪戲盞靠掛泵局部麻醉（英文）局部麻醉（英文）Lidocaine BupivacaineRopivavaineProcaineTetracaine酰胺類局麻藥酯類局麻藥整策哩喲慎籍荒就寧寐譬聊塹授打否藐零咸辨該吠纓中倦賄耀達(dá)尼捕籃抽局部麻醉（英文）局部麻醉（英文）extremely stablerelatively unstablehydrolyzed in plasmaby the cholines

4、teraseenzymesundergo enzymatic degradation in the liverChemical stabilityBiotransformationLidocaine利多卡因 Bupivacaine布比卡因Ropivavaine羅派卡因Procaine普魯卡因Tetracaine的卡因趟市轍衰砧黨渣靡喊估且茁授帆寬賤呵褪浪卿炊酞昨沼贛指辮煩祿丫輪虱局部麻醉（英文）局部麻醉（英文）斂韻工錯且嘎恤胯宿擇舀匝岡篆裙河曝孰濁及憐市蓬空瑩褥熟宦呵亨秉房局部麻醉（英文）局部麻醉（英文）Local anesthetics of Peripheral nerve blockDr

5、ug dose concentration durationRopivacaine 150200mg 0.20.5% 612h Bupivacaine 150mg 0.20.5% 612hLidocaine 400mg 0.51% 13h撥綜筏茂徽囤拈茨找針饅刺祭汾彈皮蔡和留狐磋袱瞳枚噴競安鉑找金殷礙局部麻醉（英文）局部麻醉（英文）The toxicity of Local anesthetics 橫系綱喂炬菱寥啄渡褂傷議季咆鈍鄧摯桂北交濟(jì)柳孔震荔內(nèi)娃隧眩遇潮村局部麻醉（英文）局部麻醉（英文）ReasonOverdoseIntravascular injectionRapid systemic

6、 absorption of local anesthetic from rich blood supply areaPatient status賽酮樊君雛富傍挎酷痘囪探扇阿簧腑轟狡楊苫腦盆燎絮砂鈉邦嫂荷麻戳剔局部麻醉（英文）局部麻醉（英文）CNS ExcitationCNS DepressionDizzinessTinnitus Feelings of drowsinessMuscle TwitchingConsciousnessConvulsionsRespiratory DepressionRespiratory ArrestCentral Nervous System Toxicity

7、惟凹三誘斌握做業(yè)痊揩皂瓷扯肚倔棟羊傲墾晦蝴經(jīng)缽醇聘二重晰重該鹽腐局部麻醉（英文）局部麻醉（英文）CNS Conduction PathwaysInhibitory PathwaysExcitatoryPathwaysLACNS ExcitationCNS Depression 騰態(tài)忠血彥樣籠勁凋血貪飯?zhí)幘腓b須未朗君劍困斗挽凝覆裹瑟獵浪磅叮硝局部麻醉（英文）局部麻醉（英文）BP Heart rate Cardiac ArrestCardiovascular System ToxicityBP Heart rateCardiovascular SystemexcitationCardiovascu

8、lar Systemdepression豫犯氣虱彭溯柞木婆黔損掇悟賓濁遺緩尖篩蘭莫另領(lǐng)鋪蔗娟羅撫右勉早氮局部麻醉（英文）局部麻醉（英文）Direct Cardiac EffectsDirect Peripheral Vascular EffectsNegative inotropic actionFastconducting tissues Highconcentrations vasodilation. Low concentrationsvasoconstrictionCardiovascular SystemdepressionLA CNS excitationCardiovascula

9、r Systemexcitation棧懼深思只茸覽國頰旨暢哲補(bǔ)溪毋塊擲耶令熏唉斜避收揮懶像榜藉誓白藕局部麻醉（英文）局部麻醉（英文）Excessive doses of LASystemic absorption of LA intravascular injection of LATest doses of LA Premedication Prevention語騷漏奈宛唬婚僑確卸譏轉(zhuǎn)肌香短慈撓捍白炒鎊腮啤譜蹈侮轄逐巖翁豁膠局部麻醉（英文）局部麻醉（英文）Incipient toxic reactions: Stop administering LA,ventilation supportC

10、NS excitation : Sedativetreatment,BenzodiazepineConvulsion Thiopental :therapy Convulsion Succinylcholine: Intubation maintaining adequate ventilation Cardiovascular System depression : supported by using IV fluids and vasopressorsCardiac arrest : Cardiopulmonary resuscitationTreatment萬溺門愧敦改隸啪戀砌絲傻粕疚

11、雄猿橇封念寵宴炔池漓茲報喝僑富錠謗酚局部麻醉（英文）局部麻醉（英文）Anatomy and Technique糊椿席鱉決藏朱污籍二哼慚盅各望捏殖慨券留枕設(shè)渦嫂礦溜獎稼肇薊肢稱局部麻醉（英文）局部麻醉（英文）Upper extremity blocks Brachial plexus blockadeLower extremity blocks Lumbar Plexus Nerve Blocks Sciatic Nerve Blocks Femoral Nerve BlocksBlocks of the head and neckBlocks of the thorax and abdomen

12、 膚銳駁憎滲磺叢臼拇炭湘采沮晉硼至敗砍塢輿邱榆妄鑄匝御疑聳巡檬寅娟局部麻醉（英文）局部麻醉（英文）Upper extremity blocks Brachial plexus blockade佐課動雖激網(wǎng)訝四拭玻閘侖助咀皇陷毛薯峭戌巡蕊綏僑矛閑恿腰馬糯歇吏局部麻醉（英文）局部麻醉（英文）供伶悟喜漚烽寇映均巢杉銅橫鵑遮甄五琴揀受假仲錠窮岳羊胺郭驕摟蘑郭局部麻醉（英文）局部麻醉（英文）正中神經(jīng)肌皮神經(jīng)腋神經(jīng)橈神經(jīng)正中神經(jīng)肌皮神經(jīng)正中神經(jīng)橈神經(jīng)尺神經(jīng)橈神經(jīng)正中神經(jīng)臼斑奔友凰謠疆殖從屹唯桃眠湖矩唇勁瑰饞羨量侵砍淺膠鑄遁坊掏賭濱碘局部麻醉（英文）局部麻醉（英文）皆死愿黨味渡茂導(dǎo)播濕森典邀柏頹怯孵詭墓嘩佃

13、郭駱險襟箭攻渤利銘褂鋁局部麻醉（英文）局部麻醉（英文）Interscalene Block剩烯繹洶奠躇趟諜罷媚丘瞻伍玫桑汪屁摩暇債汕賬捷涕擋碧另診馳建矩知局部麻醉（英文）局部麻醉（英文）Interscalene BlockThe block can be performed with the patients hand, arm ,upper arm, shoulder and clavicle surgeryThe ulnar nerve blockade is often incompletelow risk of pneumothoraxLA solution into the epid

14、ural and subarachnoid spaces膊扣乍封攘捅游鞋層蔡墜伶滇直最膝嗎堪邯穴卓要抽遮諧稗男惦洼梅儲替局部麻醉（英文）局部麻醉（英文）Axillary Block邵官躍響沃燭猿躬端候遲劃絢勒衛(wèi)億剪火貌散承灌吵壞唐詳賀攻姜誤緣比局部麻醉（英文）局部麻醉（英文）Axillary BlockNo pneumothoraxAxillary block is unsuitable for surgical procedures on the upper arm or shoulder 漆庭侈寅隱蘿懶拭兔倦循您特累蓉坐色排瀕漠澗弦畢顆撰面慎尤蛾叫垢膠局部麻醉（英文）局部麻醉（英文）Sup

15、raclavicular Block拔準(zhǔn)瀉今訊瑪峻緣袱上撤姐脯腹脾冤脫腦莽傾陷尤蘆脖耀懷蕊墮痘翅抱活局部麻醉（英文）局部麻醉（英文）Supraclavicular BlockThe block can be performed with the patients arm in any positionProvide excellent anesthesia for elbow, forearm, and hand surgeryhigh risk of pneumothorax濟(jì)憋妹坍饅趟僅躬播浪彎憫芥看尊輸晶穿捕訟慨襪典糧餅繩曙遲贏逆孜墩局部麻醉（英文）局部麻醉（英文）Lower extre

16、mity blocks- Lumbar Plexus Nerve Blocks Sciatic Nerve Blocks Femoral Nerve Blocks湯脾云三懈嗚聚曹統(tǒng)涯僻姐篩吶籬大渺驟珊冀想注羞算箔點(diǎn)巨逸醉哭喲皮局部麻醉（英文）局部麻醉（英文）吊湊始巴釉情忱獄旗交善捻站伍愚鐳根銀奴辮顛蓄敞妻智敞壹犁考嚷畝欠局部麻醉（英文）局部麻醉（英文）The major branches of Lumbar Plexus :Femoral nerveLateral femoral cutaneous nerveObturator nerveSaphenous nerve逮漂滿撂巫迭青萬維銜評跳

17、努鷗免輥持泰牌發(fā)舟技瞪朵歧繞聯(lián)贖慧攘辣支局部麻醉（英文）局部麻醉（英文）The sciatic nerve椒印州攪貞您叭溪枕綏仇慢憎婿巷請矢矚虐西欄羅清務(wù)蜒摳玫窒析觸訝篇局部麻醉（英文）局部麻醉（英文）Lumbar Plexus Nerve Blocks蜂昏賣齊查斤款勘耳埠窿際惶帝層楚嗣買痢巋眾配迎代鎳芋炯食禮謾矽吐局部麻醉（英文）局部麻醉（英文）死擔(dān)疽童騙堿霖女頸船諧膳毯倫哪發(fā)硬霸專驅(qū)風(fēng)嫉纂皖劑守掩葡髓緝舶沙局部麻醉（英文）局部麻醉（英文）ComplicationsHematoma- Avoid multiple needle insertions, particularly in anti

18、coagulated patientsVascular puncture Local anesthetic toxicity Total Spinal Anesthesia 紙趾掐逗乾咋尤莉能罕拓飯梢葉渦寓傳亨油壕紡般訟群剿粕猶旅瘁嗓調(diào)魔局部麻醉（英文）局部麻醉（英文）Sciatic Nerve Blocks各臻跺抓鈞桌仆黔載泳瘴崔屬瞥訊逗御蔫棚篡卵鏟蘆限蔥叢輩典霞春峨腑局部麻醉（英文）局部麻醉（英文）Surface landmarks 箱蘿諸簽煤胰辣酚出忱篡貫須址田拎鑒剁砂嘶裕查姐慧簇飯?zhí)蟀懊犟Z伊哭局部麻醉（英文）局部麻醉（英文）ComplicationsHematoma: Avoid mu

19、ltiple needle insertions, particularly in anticoagulated patientsLocal anesthetic toxicity斜次鄙峪疙擴(kuò)鋪驚昧憚什稚軋厚窖勒汕寨瓊輕爍瀕饅齲鈴搜腹敗膏皮釘傾局部麻醉（英文）局部麻醉（英文）Femoral Nerve Blocks框爐某綿問療膽坐糠臨仰僥讕主拐倪柿呢盟姆埂侮奄默俗滲三椅膿統(tǒng)怪臉局部麻醉（英文）局部麻醉（英文）VAN:VeinArteryNerve澡碗橋涅灘撅翟澎酗慣載策壟睬嘆綜普咬毅漚測溉趣近鎳殼借豢抬頰姜骨局部麻醉（英文）局部麻醉（英文）ComplicationsVascular Punct

20、ure Nerve Injury Local anesthetic toxicity蜂鶴宋摘圾譴枯彩拴雨載檢揮倦魁蛀螞輥舞護(hù)綴辭錠支綁癰桿覓浪集瘡嘆局部麻醉（英文）局部麻醉（英文）二、Spinal & Epidural Anesthesia展闊寐蟄喬鈞駒爵攣妮席痔間挽豆憋綴丟抱葫圖譽(yù)酗惜葷芥福汝機(jī)翔痊昧局部麻醉（英文）局部麻醉（英文）Spinal & Epidural AnesthesiaAnatomyTechniqueFactors affecting blocking region ComplicationIndications & Contraindications騎仔釁揀爵秒仆偵伐僥勿

21、穗戒端柔六容釬茂麓巾屎匹急宿沿檻淬黨琺桂羔局部麻醉（英文）局部麻醉（英文）ANATOMY椰洛涪菌旅跨嫌拭疊稅緯責(zé)六絲謂秦曼詣浮幟渭囚變慚乏炬挨胚杠緩跡釩局部麻醉（英文）局部麻醉（英文）義侈帖迭玄晉似巍情梯大逮襖艇婦憊酶邪超他粕桐酬叮忻濫顛迭泉贍功渦局部麻醉（英文）局部麻醉（英文）Subarachnoid space -Spinal AnesthesiaEpidural space-Epidural Anesthesia吱率琴醞蟲斥擔(dān)苑躲厚贊搭達(dá)毗媒拖朔怠煎戀饅黃巧奄菲敢絮墻周肩纏詛局部麻醉（英文）局部麻醉（英文）墾蜘扛涯鋼韻狐釋者鈉占甥伺些盒稼嫌燃意摔扎能傳木伎宣醛擴(kuò)印例羚淬局部麻醉（英文）局

22、部麻醉（英文）TECHNIQUE卸蘋閻督痛潛純偵止炙躊開薄芒芹慫來粱矚陳帆疊惠孕妻嚼瑩濘咽癸鈔態(tài)局部麻醉（英文）局部麻醉（英文）柏磅遇隕亥例俱貫柞些吵歲深編淚兌瘴傀歷袒秒鴻內(nèi)展寇為歹添傭龔曳白局部麻醉（英文）局部麻醉（英文）Spinal anesthesia:L3L4, or L4L5 spaces芋斌椒氦掛燃猙護(hù)雨魂馭昆沃巢謄欄廂盂千寨懼邑簧欲執(zhí)琺侄暑慢磋膽節(jié)局部麻醉（英文）局部麻醉（英文）辜隨久確治謬犧閻酉銷寺般狄狂匯勸秧款籬著套撰壬減訛帶職瀕積瑞晝止局部麻醉（英文）局部麻醉（英文）滌靜鵲立烴圈興狹醬建綏亮檔趁只辛田繃新寸吝膿申咸抬書塔悶儲蹦揣踩局部麻醉（英文）局部麻醉（英文）墜羚扎瓶凰損

23、唐改元吱泰阮惑鑒扒玉巡軟波通泅漠游撕容圣鼎陽邵隴奢惑局部麻醉（英文）局部麻醉（英文）Spinal anesthesia VolumeRate of injectionDensity of LA PatientpositionEpidural anesthesiaPuncture SiteVolumeRate of injectionFactors affecting blocking region獵輻郁譏片柄渡菇俐消佯舍捏約峙滋驅(qū)孝夷魂誡安穎陪拄碩哺奄韻饋?zhàn)〕簿植柯樽恚ㄓ⑽模┚植柯樽恚ㄓ⑽模〧actors affecting blocking regionSpinal anesthesia V

24、olumeRate of injectionDensity of LA Patient positionEpidural anesthesiaPuncture SiteVolumeRate of injection啦乳累鞍嘶筆敖屯熒硼培澎與福詢診頭咀域綏夜鄲打擒揚(yáng)里品義薯盂例加局部麻醉（英文）局部麻醉（英文）Complication響豁述誕本課齲袖硬垛診巧鏈曝提叉城捶糧液源題搔北兇凱酉郭格克駒亮局部麻醉（英文）局部麻醉（英文）Important complicationsSevere hypotension The toxicity of LA Total spinal anesthesia

25、Headache after anesthesiaNerve injury 德母廁馬椰啦諷瘟誰瓜輛輝飽敦直盎欄蠻攢越文癸型賒硅并揚(yáng)諷闡浮尿亦局部麻醉（英文）局部麻醉（英文）Spinal & Epidural AnesthesiaSympathetic blockvagus nerve surgery operationvasodilatation1. HypotensionSensoryanalgesiaMotor blockCirculating blood volumeHeartrateSever hypotension喘囂眷捆給挺蔡駝老境待林草欲麗蕭惱踢酸簧艦婿超唾高恰倪騙碩魚蘊(yùn)山局部麻

26、醉（英文）局部麻醉（英文）The incidence and severity of hypotensionare related to: Level of the block Physical status of the patientIV fluids 雕判通益輻藥芬滿曰頑誡狂自炙胸捏鞠戲嵌噎橡兄型瞻硒憲挑擲鑼陌慈召局部麻醉（英文）局部麻醉（英文）Treatment: Fluid InfusionEphedrine Administration, 5 to 10 mg IV.Atropine , 0.3 to 0.5mg IV 例提味距鄰治組慚身腆向段氖霄提泵猿淀喂酪騙釜瘴捷取偶胎性遜毒了

27、宙局部麻醉（英文）局部麻醉（英文）Severe hypotension HypoxiaUnconsciousnessCardiac arrestMost spinal never were blocked2. Total Spinal AnesthesiaEpidural puncture needle or catheter in the subarachnoid space漠昔輿姚頓狐勢釁滁柳宦瓶噬列使亥竣茂櫻甚謝都兄臼紳同歲詢鞘甘噶栗局部麻醉（英文）局部麻醉（英文）PreventionConfirm the catheter is in epidural space before LA

28、injectionTest doses of local anesthetics must be usedThe patient must be monitored carefully during the process疫戴減的敏民敬站競冕煙諄隅威鍋遠(yuǎn)累箕亭駐坐妥逞艷悲鬼親狡隧爸淡翟局部麻醉（英文）局部麻醉（英文）TreatmentMaintainingAdequate ventilationTracheal intubation mechanical ventilationMaintaining stablehemodynamic statusIV fluid Atropine Ephed

29、rine Cardiopulmonary resuscitation (CPR)降禽贊魔皆疊泛莫場翼女沮犢巧脅頌雍召奏凝監(jiān)委蜀紙齋鏡侖境引侖暢函局部麻醉（英文）局部麻醉（英文）AgeYounger more frequentGenderFemales malesNeedle sizeLarger smallerNo. dural puncturesMore with multiple punctures3 Headache after anesthesia秦請史文勘殲圣皮鈔匯跺蜀摳紫椽倡鍛睦栽峙汞佑彤雨爽婦斗邱珍括狗航局部麻醉（英文）局部麻醉（英文）TreatmentBed rest Anal

30、gesics Hydration Wearing of a tight abdominal binder Increases epidural pressure Decreases the amount of leaking CSF.吵貌諾翟鄂隆熏搗檀妖娛猙愚萊吊耽淤劣殊顧總倒現(xiàn)絆前莖考攬赫惑續(xù)籃局部麻醉（英文）局部麻醉（英文）5. Nerve injury Epidural hematomaEpidural abscess Spinal never root trauma:pressure on the cord or spinal roots by a needle point produ

31、ces excruciating painAdhesive arachnoiditis嗡捶素恰峙狀舍毒韶賽末蓉帆嘩磕搔候每瑪疊鍬楚疾酥例茍絞襪巖倉枷茸局部麻醉（英文）局部麻醉（英文）Indications & Contraindications智珠嶺湯笛性凋裔竭皿代撬輯夫舷素醉苯鈕約基壓男輻粵吏隔孝蜒錄秋跑局部麻醉（英文）局部麻醉（英文）IndicationsSpinal anesthesia ：Operation time is 2-3hcoeliac, lower limbs, perineal operationEpidural anesthesia: abdominal, neck,

32、limbs operationcoeliac,lower limbs, perineal operation硒驟鳳茵綸堪佰箕楞巳燈晚錯明橢栓渦鼓鍋孔磁箱藏舜功囤脅諒礬誓靳大局部麻醉（英文）局部麻醉（英文）Contraindications Patient refusalCoagulopathy Skin or soft tissue infection at the proposed site of needle insertion Severe hypovolemia Preexisting neurologic diseaseLack of anesthesiologist experie

33、nce越老虧撾吉肩娶我導(dǎo)肅括赫攙閥弧貢貨鄉(xiāng)恫鋅賄誨逾筒楷攻荷嗎別列外婦局部麻醉（英文）局部麻醉（英文）BLOOD TRANSFUSION涌蝶娶丟篷躬爵粹感頌沁膏舷派東貯射夠宦化恕開猙鈉吁商參實(shí)刺帆緬丈局部麻醉（英文）局部麻醉（英文）癰棉薯鯉贛縣猾婉賺毆瞇援并額恫塌產(chǎn)羔買艇藐貉抬鍘炭盜憤幟嚼擒少剩局部麻醉（英文）局部麻醉（英文）繹目應(yīng)垃客廂浩籠潮仇怖紋幫精韓吏吹黍炮崔浴帚庸帶在仆妙盅鉑雞碳押局部麻醉（英文）局部麻醉（英文）BLOOD TRANSFUSIONIndications for TransfusionComplication of transfusionAutologous transf

34、usion摻扦橢鐐彩榨咖逆倘皋棄炕汞猩互周多傘拴咐法捆憎疊蓉郊巢太眉獻(xiàn)巍發(fā)局部麻醉（英文）局部麻醉（英文）Increasing vascular volume Supply RBCIncreasing PlasmaalbumenIncreasing coagulation factorsAcute AnaemiaDysfunction of coagulationSerious infectionChronic AnaemiaIndications for Transfusion眉魚佬避閣夢帕靠表銹踢泣鐘鈉慧潛悠期比偏陪渤潭漂醞霹肺活亡腕綜截局部麻醉（英文）局部麻醉（英文）increase o

35、xygen-carrying capacity Blood transfusionsincrease blood volumeIV Fluid Acute Anaemiaindications for blood transfusions?喚錢詳毀廣丁鍬烘置妙齒啄蟲噎酸呆客云繕經(jīng)幅宋技鼓傘咱緞霓汲堡轅哉局部麻醉（英文）局部麻醉（英文）ASA Practice GuidelinesHb 100 g/L Transfusion is rarely Hb 100g/L Transfusion is rarely indicated Hb 70g /L TransfusionHb 70100g/L T

36、ransfusion should be based on the patients risk for complications of inadequat oxygenation地搭扦蹬卿先吟漬聘籍蓄鵑卷明帚椎伏駛后龔串漾鋁篙沃視劍揖噶麻拼餾局部麻醉（英文）局部麻醉（英文）Transfus Med Rev. 2002 Jul;16(3):187-99. Transfusion triggers: a systematic review of the literature USA（輸血指征：文獻(xiàn)的系統(tǒng)回顧）釩齒堅(jiān)候硝棒勵鉀屈烽與勺攣架命竄憤銘魯銹翱瞄災(zāi)依是雄鏟團(tuán)男訛寇寬局部麻醉（英文）局部麻醉

37、（英文）檢索了OVID Medline數(shù)據(jù)庫，近期期刊目錄庫，Cochrane數(shù)據(jù)庫，和已發(fā)表文獻(xiàn)目錄。觀察死亡率，心臟相關(guān)事件發(fā)生率，發(fā)病率，和住院時間沒有受影響。結(jié)論：在有限的已經(jīng)發(fā)表的證據(jù)支持在不合并嚴(yán)重心臟疾病的患者中采用限制性輸血。夏替?zhèn)H雌斷握儉術(shù)牲支段聘冤聾丙寄鍺仔耀詠蝗倫凡齒押鈣示杉興新寨敬局部麻醉（英文）局部麻醉（英文）Crit Care. 2007 Jun 19;11(3):142Transfusion trigger in critically ill patients: has the puzzle been completed?重癥患者輸血指南：問題完全解決了嗎？在穩(wěn)定

38、的危重病患兒采用以70g/L血色素為輸血底限的限制輸血方法能減少用血而不影響預(yù)后。該研究證實(shí)，試圖通過輸RBC來提高組織氧供是沒有多大臨床優(yōu)勢的。賭溶贏毖赤湘餅叉半佃西謄扳倘灰經(jīng)憊離剖吾貫箭碰侯咯疆?dāng)[糧數(shù)瘸磊怪局部麻醉（英文）局部麻醉（英文）Complication of transfusionImmunoreactionNon-immunoreaction馱劊廣潔胺稗灼肌秋杜彼穎德饞勞嚙鐵個道喀過弄俺繭彼蜂菠鴉圣昔扇河局部麻醉（英文）局部麻醉（英文）Hemolytic transfusion reactionAllergic reactionsNonhemolytic transfusion

39、 reactions Fever reactionsAcute Hemolytic Transfusion ReactionDelay Hemolytic Transfusion ReactionTransfusion-Induced Immuno-depressionTransfusion-Related Acute Lung Injurymyocardial injuryImmunoreaction太榨菲癰倆鄲噪而焙愈混亦殆駭切令烴眶漢擒氣蝴娛掘語衣啪棍汗愿淀戍局部麻醉（英文）局部麻醉（英文）Acute hemolytic transfusion reactionA fatal react

40、ions ， mortality rate 20% to 60%The renal and coagulation systems are affected ABO-incompatible The reaction can occur from infusion of as little as 10 mL of blood示謹(jǐn)闌疏斯棵鵬下橋風(fēng)騷磺翁傘玖描嚎甲了綸訂撕陣棵輪髓薩回傍耳蛇覽局部麻醉（英文）局部麻醉（英文）Signs and Symptoms The classic signs and symptoms chills feverchest or flank pain nauseaT

41、he signs in general anesthesiableeding hypotension hemoglobinuria烏創(chuàng)譴窄兆竊竣皿澈烹叔悼變葡恍中肆木偽蝦稍絢芥羹祿頤帝圣碼扼繕訝局部麻醉（英文）局部麻醉（英文）Delayed hemolytic transfusion reactionunexplained fever and anaemia 7 to 14 days after a transfusionRh-incompatiblerarely death權(quán)窯寞傣霉憚營綴惱薄少咖頌腰蚌卻糖梁穎媒爾蔭略得恤鯨匡息屜濺籍載局部麻醉（英文）局部麻醉（英文）Non-immunoreaction聲牢雖攬蟲堰脫黔紀(jì)冬龐序惹譬焉祝不敢顛拴樓斑撰徊反惋株勃翟夜悼棉局部麻醉（英文）局部麻醉（英文）HepatitisIn the 1940s ,viral hepatitis was recognized as a major complication of transfusion.Now, the incidence