復合麻醉與聯(lián)合麻醉醫(yī)學PPT課件

1、復合麻醉與聯(lián)合麻醉1復合麻醉(balanced anesthesia)及聯(lián)合麻醉（combined anesthesia)的定義復合麻醉的應用原則靜吸復合麻醉與全憑靜脈麻醉的比較聯(lián)合麻醉的優(yōu)缺點2復合麻醉(balanced anesthesia)及聯(lián)合麻醉（combined anesthesia） 的定義The concept of balanced anaesthesia today is that a combination of anaesthetics will act synergistically with respect to desired effects such as hy

2、pnosis or analgesia, but not with respect to side-effects.聯(lián)合麻醉是指同一麻醉過程同時或先后采用兩種或兩種以上的技術(shù)3理想的麻醉狀態(tài)不僅僅局限于無痛、肌肉松弛和意識消失有效地調(diào)控機體的應激狀態(tài)維護重要生命器官和系統(tǒng)的功能消除惡性刺激對病人生理及心理的影響4復合麻醉的應用原則合理的選擇麻醉藥物和劑量準確地判斷麻醉深度加強麻醉管理優(yōu)化用藥方案堅持個體化原則不同麻醉技術(shù)的聯(lián)合使用5臨床常用的復合麻醉方案1.靜吸復合麻醉Propofol+Fentanyl+Esmeron 誘導插管Sevoflurane+Remifentnil 維持2.全憑靜脈麻

3、醉（TIVA or TCI）Propofol+Fentanyl+Esmeron 誘導插管Propofol+Remifentanil 維持6兩種方法的比較1.對顱內(nèi)壓的影響2.對術(shù)后惡心嘔吐的影響3.對HPV的影響4.術(shù)中體動的發(fā)生率5.對蘇醒速度的影響 6.經(jīng)濟效益的比較7吸入麻藥的藥代動力Figure 1. The 80% decrement times of volatile anaesthetics. By analogy with the context-sensitive half-time, the decrement time describes the decay of the

4、 alveolar concentration with the time of administration. The 80% decrement times of both sevoflurane and desflurane are less than 8 minutes and do not increase with the duration of anaesthesia. However, the 80% decrement times of isoflurane and enflurane increase significantly after approximately 60

5、 minutes of anaesthesia, reaching plateaus of approximately 3035 minutes. The 80% decrement time correlates closely with the clinically observed recovery of consciousness.8阿片類藥物的時效敏感半衰期The CSHT of remifentanil is less than 5 minutes, independently of the time of administration.9Propofol時效敏感半衰期The CS

6、HT of propofol is 15min after a 2-hour infusion10兩種方法的選擇顱內(nèi)占位性病變手術(shù)腔鏡手術(shù)某些胸科手術(shù)高危嘔吐病人的手術(shù)耳鼻喉短小手術(shù)講者更多傾向于選擇Propofol-based anesthesia11Pearlsutilization of ultra-fast-acting compounds needs planning of postoperative analgesia at least during anaesthesia, or better, before the start of anaesthesiaMulti-model

7、 analgesia (including NSAID, nerve block, local infiltration, opioid, etc) should be considered 12聯(lián)合麻醉的優(yōu)點可以達到更完善的麻醉效果， 病人圍術(shù)期安全性更高消除病人對手術(shù)和麻醉的恐懼心理和精神緊張減少全麻中鎮(zhèn)痛藥的用量，或局麻藥的應用，從而減少全麻或局麻藥物所帶來的毒副作用和不良反應減少靜脈麻醉藥或吸入麻醉藥的應用，病人術(shù)后蘇醒迅速、恢復快可以減少肌松藥的用量術(shù)后保留硬外導管，可以提供完善的術(shù)后鎮(zhèn)痛13硬外復合全麻的優(yōu)點14硬外復合全麻的優(yōu)點硬外麻醉可以降低全麻術(shù)中麻醉性鎮(zhèn)痛藥及麻醉藥的需求，加快術(shù)后蘇醒及降低麻醉性鎮(zhèn)痛藥相關(guān)的各種并發(fā)癥對于上腹部手術(shù)病人可