腹、盆腔手術(shù)的麻醉chapter21anesthesia(已修改)
2025-02-02 14:01 本頁面
【正文】 腹、盆腔手術(shù)的麻醉 Chapter 21 Anesthesia for operations in abdominal and pelvic cavities 湘雅臨床麻醉教研室 第一節(jié) 、 腹、盆腔手術(shù)麻醉的特點(diǎn) The features of anesthesia for operations in abdominal and pelvic cavities 腹、盆腔臟器的主要生理功能和圍術(shù)期病理生理變化 ? The ans in abdominal and pelvic cavities include digestive system and genitourinary system. ? The main physiological functions are digestion, absorption,metabolism, elimination, immune function and secretion. ? The adequate preoperative preparation should be done to avoid anesthetic plications. 腹、盆腔手術(shù)圍術(shù)期液體管理 ? Severe bleeding(massive hemorrhage), massive loss of body fluid,internal redistribution of fluids— often called “third space” can cause severe intravascular depletion. ? The fluids infusion rate is 10ml/kg/h and the crystalloid and colloid solutions should be administered properly. ? When the danger of anemia outweighs the risks of transfusion, further blood loss should be replaced with transfusion of red blood cells to maintain hemoglobin concentration or hematocrit. 手術(shù)體位 (Patient?s position in operation）對(duì)生理功能的影響 截石位（ Lithotomy position） 頭低位（ Trendelenburg position） Lithotomy position and Trendelenburg tilt would result in changes in pulmonary blood volume, a decrease in pulmonary pliance, a cephalad shift of the diaphragm, and a decrease in lung volume parameters. Cardiac preload may increase. Nerve injuries to the mon peroneal, sciatic, and femoral nerves are likely. 腹壓對(duì)生理功能的影響 ? Increased abdominal pressure and elevation of diaphragm lead to dyspnea. ? Anesthetic agents,anesthetic techniques and rapid depression exacerbate vasodilatation, decreased venous return to heart and cardiac output. The measures should be taken: ? Administration of IV fluids. ? Modulate the position. ? Administration of ephedrine. ? Avoid rapid depression. 腹、盆腔手術(shù)對(duì)肌松弛的要求 Complete neuromuscular blocking is required in operations. 腹、盆腔手術(shù)中的內(nèi)臟牽拉反應(yīng) Distension of viscera or traction on peritoneum may induce bradycardia, reducing of arterial pressure and cardiac arrest. ? Vagus reflexion and pelvic nerves reflexion ? Mesentery traction syndrome 腹、盆腔急癥手術(shù)的特點(diǎn) ? Preoperative assessment History and physical examination Full stomach Hypovolemia Fluid and electrolytes disturbance Acidbase unbalance ? Preparation for emergency operations 第二節(jié)、 腹、盆腔手術(shù)的常用 麻醉方法 The monly used anesthesia techniques for surgery in abdominal and pelvic cavities 一 . 局部麻醉（ local anesthesia) ? Local infiltration anesthesia ? Field blocking anesthesia ? Intercostal block Advantages. Disadvantages. 二 .椎管內(nèi)麻醉（ intravertebral anesthesia） anesthesia, epidural anesthesia One site , two sites anesthesia a. Single dose b. Intermittent bolus via a catheter spinal and epidural anesthesia 三 .全身麻醉（ General anesthesia
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1