嚴(yán)重創(chuàng)傷病人的麻醉

嚴(yán)重創(chuàng)傷病人的麻醉

精選課件overview

Inadvancedcountries,injuryranksasthethirdleadingcauseofdeathfollowingheartdiseaseandcancer.精選課件Treatmentprincipleto

criticallyillpatientsAssessmenttoorganfunctionanddiseasestatesPreoperativetreatmentSelectiontoanesthesiawayandanestheticsCloseintra-operativemonitoringandcorrectiontoabnormalityofpathophysiologicalstatePositivepreventionandtreatmenttoPostoperativecomplications精選課件PreoperativeAssessment精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件精選課件心功能分級及意義級別屏氣臨床表現(xiàn) 臨床意義麻醉試驗I級>30s能耐受日常體力活動心功能正常耐受力活動后無心慌良好氣短等不適II級20～30s日常體力活動有一定不適，心功能較差如處理適當(dāng)自行控制活動量，耐受仍好不能作跑步或用力的工作III級10～20s輕度或一般體力活動后心功能不全麻醉前應(yīng)充分準(zhǔn)備心悸、氣短明顯，應(yīng)避免增加心臟負擔(dān)只能勝任極輕微的體力活動或靜息IV級10s以內(nèi)不能耐受任何體力活動，心功能衰竭極差，一般需推遲

靜息時也感氣短，不能平臥，有端坐呼吸、心動過速等表現(xiàn)精選課件5.5Assesstobloodlossofdamageindifferentparts

Estimationtobloodloss（ml）PositionModeratedamageSeveredamage

Upperlimb

5001000Calf

5002000Thigh

10003500Pelvis10004000Abdomen10005000Chest10004000 精選課件精選課件Characteristicsofseveretraumapatient'scondition

1病情緊急注意檢查和治療的矛盾2病情嚴(yán)重

失血性休克發(fā)生率可達95%3病情復(fù)雜

復(fù)合傷居多4疼痛劇烈5飽胃

急診病人一律視為飽胃病人

精選課件anesthesiacharacteristicsofSeveretraumapatients

1不能耐受深麻醉2難以配合麻醉3難于避免嘔吐誤吸4麻醉藥作用時間明顯延長5常伴有不同程度脫水、酸中毒6常需支持循環(huán)功能疼痛劇烈病情嚴(yán)重病情復(fù)雜病情嚴(yán)重病情復(fù)雜病情緊急飽胃病情嚴(yán)重精選課件Firstaidandtreatmentbeforeanesthesia

原則積極準(zhǔn)備而不延誤手術(shù)時機㈠確保呼吸道通暢及充分供氧⒈導(dǎo)致缺氧的原因通常有：⑴呼吸道梗阻：神志不清、昏迷、舌后墜、分泌物、嘔吐⑵中樞性呼吸抑制：顱腦損傷⑶胸外傷⒉處理方法：⑴通暢呼吸道：吸引、口咽通氣道、氣管插管、氣管切開⑵充分供氧：鼻導(dǎo)管、面罩、機械通氣

⑶多發(fā)傷病人應(yīng)假定有頸椎損傷而做頸椎固定精選課件精選課件精選課件PrinciplesofanesthesiaPremedicationAnalgesic，Sedative，Anticholinergics

Methodofanesthesia

1.localanesthesia-----itissuitabletoSuperficialsurgeryanddosesshouldbenoted⒉intravertebralanesthesia-----Caution?、砱eneralanesthesia-----Common，Lightanesthesiaisappropriate精選課件Methodofgeneralanesthesia1anesthesiainduction

1.1Preventivemeasuresofrefluxandaspiration

Largediameterofgastrictube

Antacids:Cemitidine200~400mgAwaketrachealintubationaftertopicalanesthesiaCricoidpressurebeforeintubationInflateendotrachealtubecuffAppropriatedoseanti-cholinergicdrugsInjectenon-depolarizingmusclerelaxantsbeforeSuccinylcholin

精選課件精選課件精選課件精選課件5Circulationandrespiratorymanagementduringanesthesia

5.1Circulationmanagement5.1.1maintainbloodpressure

bloodvolumesupplement:Crystalloid,colloid,blood,plasmaVasoactivedrugs:dopamine3~15μg/kg/min精選課件5.1.2AntiarrhythmicDrugsslowdowntheheartrateafterensuringventilationandoxygensupply,andeliminatinglowbloodvolume5.1.3heartfunction

Cedilanid5.1.4Microcirculation

Dextran,scopolamine,654-2,corticosteroids,etc.