临床麻醉学绪论 Introduction of Clinical Anesthesia.ppt

内分泌 甲状腺激素 血糖 肾上腺皮质激素 生化指标 HB、RBC、WBC、Hct、Plt Proteins: Total, albumin, globulin Cre, BUN Blood Glucose Ion: potassium, natrium, chlorine, calcium, magnesium ASA physical status I.? A normal healthy patient?? II. A patient with mild systemic disease?? III. A patient with severe systemic disease? IV. A patient with severe systemic disease that is a constant threat to life? V. A moribund patient who is not expected to survive without the operation VI. A declared brain-dead patient whose organs are being removed for donor purposes The addition of an E indicates emergency surgery. 麻醉和手术的危险因素 病情 手术 麻醉 医疗条件 了解麻醉前的用药情况 抗高血压药 肾上腺受体阻滞药 降糖药 扩冠药 抗凝药 单胺氧化酶抑制药：术前停2周以上 三环类抗抑郁药：术前停2周以上 知情同意 学会沟通方法和技巧 在交待病情时不能让患者或其家属恐惧 逐项交待好术中可能发生的各种情况，并取得其谅解 填写好医疗文书，并有患者或其家属签字。 总结 了解麻醉的发展历程，会感悟一些道理，不断探索追求才能更好地发展 熟悉麻醉学的工作范畴，将会更好地全面发展，做一名真正的医生 麻醉前的访视，加强与患者或家属的沟通，取得他们的信任。要了解病情并发现病人潜在的疾病，对病人进行体格检查和评估，也标志着麻醉医生的水平所在 准确地检查出阳性所见，结合其他辅助检查结果，得出一个正确的结论，会大大提高手术成功率，降低并发症的发生率，保障病人的安全十分重要。 病例分析 50岁男患，晚上朋友聚会喝酒，突发左上腹持续性剧痛或刀割样疼痛，上腹腰部呈束带感 在运往医院途中呕吐2次 普外科医师初步诊断为急性坏死性胰腺炎，拟行剖腹探查术 问题：从麻醉方面病人存在什么问题？麻醉需要做哪些准备？如何麻醉病人才最安全？ 思考的问题 怎样才能让患者在围术期不痛苦? 怎样才能使手术更顺利? 过去是怎么麻醉的? 麻醉现状? ASA 分级 * Popular anesthesia words ASA physical status classification system TOF: train of four BIS: bispectral index SG: Swan Ganz catheter MAC: minimum alveolar concentration TEE: transesophageal echocardiography Else The working field of Anesthesiologists Clinic anesthesia Operating room, PACU, outpatient, CPCR (cardiopulmonary cerebral resuscitation) CCM (critical care medicine) Analgesia Pain clinic, postoperative analgesia, others Others Research, education, training How can you become a real anesthesiologist purpose Basic knowledge Focus on the patients Profile of whole body systems Using your potential to find out new point Renew and update, uninterruptedly Communication Anesthesia methods general local balance Nerve block epidural spinal topical inhalation intravenous mucosa muscle Local infiltration General local Subspecialty of anesthesiolo