最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件

全麻下肢手術(shù)中止血帶反應(yīng)的處理Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL全麻下肢手術(shù)中止血帶反應(yīng)的處理1病歷摘要29歲男性,體重:61kg,身高:153cm◎診斷:脛骨上端閉合性骨折◎擇期全麻下:脛骨干骨折切開復(fù)位內(nèi)回定術(shù)o既往史:生長受限,多次骨折史ASA邛級◎麻醉方式:全麻+神經(jīng)阻滯chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病歷摘要2術(shù)前檢查oHb151g/dL,Hct43.7%,Plt194*109/LOALT53U/L,AST31U/LoG凵U3.6mmo∥L,UREA50mmo∥L,CREA60umol∥LoECG:竇性o胸片:正常chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL術(shù)前檢查3病例摘要o09:00入室HR1122次/分,BP160/120mmHg,SpO299%o09:00-10:00力月西1mgⅳ,舒芬太尼5ugⅣv,坐骨神經(jīng)阻滯,HR110120次/分,BP160175/100-120mmHg,SpO299%◎10:00全麻誘導(dǎo):異丙酚TcI4ug/ml,舒芬太尼20ugⅣ,順式阿曲庫銨12mgⅣ,HR60次/分,BP160/120mmHgchAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病例摘要4最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件5術(shù)為式肚千骨折切開復(fù)位內(nèi)固定術(shù)前用內(nèi)阿托方式全坐骨神段阻滑chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL術(shù)為式肚千骨折切開復(fù)位內(nèi)固定術(shù)6◎術(shù)中高血壓:血壓升高超過麻醉前20%或血壓升高達165/95mmHg°血壓過高:血壓升高超過麻醉前30mmHg°麻醉淺?o缺氧?ocO2蓄積早期?o甲狀腺功能亢進、嗜鉻細胞瘤?◎術(shù)前精神高度緊張?chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL◎術(shù)中高血壓:血壓升高超過麻醉前20%或血壓升高達165/97止血帶全身影響:心血管、呼吸、腦、體溫、代謝局部影響:神經(jīng)、肌肉、皮膚chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL止血帶8全身影響一心血管系統(tǒng)止血帶充氣◎循環(huán)血量+,全身血管阻力+→cvP+SBP+o雙下肢驅(qū)血:增加15%(約800m)血量止血帶充氣30-60minOHR+SBP+,DbpTOurniquetPain對鎮(zhèn)痛藥物不敏感,加深麻醉深度效果不明顯止血帶放氣mo回心血量+缺血后反應(yīng)性充血→cvP-,BPPC.AKam,,etal.Thearterialtourniquet:pathophysiologicalconsequencesandanaestheticimplications.Anaesthesia,2019chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL全身影響一心血管系統(tǒng)9TourniquetpainoProlongedtourniquetinflationduringgeneralanaesthesiacausesincreasesinheartrateandbloodpressure,whichcommonlyleadtheanaesthetisttoincreasethedepthofanaesthesiathisclinicalsyndromeiscommonlyreferredtoastourniquetpain長時間止血帶充氣后,全麻患者出現(xiàn)心率、血壓上升。067%全麻患者發(fā)生tourniquetpaino與高齡、手術(shù)時長相關(guān),常發(fā)生在下肢手術(shù)ValliHRosenbergPH,KyttaJ,etal.Arterialhypertensionassociatedwiththeuseoftourniquetwitheithergeneralorregionalanaesthesia.ActaAnaesthesiolScand1987;chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLTourniquetpain10最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件11最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件12最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件13最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件14最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件15最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件16最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件17最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件18最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件19最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件20最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件21最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件22最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件23最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件24最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件25最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件26最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件27最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件28最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件29全麻下肢手術(shù)中止血帶反應(yīng)的處理Evaluadononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL全麻下肢手術(shù)中止血帶反應(yīng)的處理30病歷摘要29歲男性,體重:61kg,身高:153cm◎診斷:脛骨上端閉合性骨折◎擇期全麻下:脛骨干骨折切開復(fù)位內(nèi)回定術(shù)o既往史:生長受限,多次骨折史ASA邛級◎麻醉方式:全麻+神經(jīng)阻滯chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病歷摘要31術(shù)前檢查oHb151g/dL,Hct43.7%,Plt194*109/LOALT53U/L,AST31U/LoG凵U3.6mmo∥L,UREA50mmo∥L,CREA60umol∥LoECG:竇性o胸片:正常chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL術(shù)前檢查32病例摘要o09:00入室HR1122次/分,BP160/120mmHg,SpO299%o09:00-10:00力月西1mgⅳ,舒芬太尼5ugⅣv,坐骨神經(jīng)阻滯,HR110120次/分,BP160175/100-120mmHg,SpO299%◎10:00全麻誘導(dǎo):異丙酚TcI4ug/ml,舒芬太尼20ugⅣ,順式阿曲庫銨12mgⅣ,HR60次/分,BP160/120mmHgchAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病例摘要33最新-全麻下肢骨科手術(shù)中止血帶反應(yīng)的處理課件34術(shù)為式肚千骨折切開復(fù)位內(nèi)固定術(shù)前用內(nèi)阿托方式全坐骨神段阻滑chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL術(shù)為式肚千骨折切開復(fù)位內(nèi)固定術(shù)35◎術(shù)中高血壓:血壓升高超過麻醉前20%或血壓升高達165/95mmHg°血壓過高:血壓升高超過麻醉前30mmHg°麻醉淺?o缺氧?ocO2蓄積早期?o甲狀腺功能亢進、嗜鉻細胞瘤?◎術(shù)前精神高度緊張?chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL◎術(shù)中高血壓:血壓升高超過麻醉前20%或血壓升高達165/936止血帶全身影響:心血管、呼吸、腦、體溫、代謝局部影響:神經(jīng)、肌肉、皮膚chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL止血帶37全身影響一心血管系統(tǒng)止血帶充氣◎循環(huán)血量+,全身血管阻力+→cvP+SBP+o雙下肢驅(qū)血:增加15%(約800m)血量止血帶充氣30-60minOHR+SBP+,DbpTOurniquetPain對鎮(zhèn)痛藥物不敏感,加深麻醉深度效果不明顯止血帶放氣mo回心血量+缺血后反應(yīng)性充血→cvP-,BPPC.AKam,,etal.Thearterialtourniquet:pathophysiologicalconsequencesandanaestheticimplications.Anaesthesia,2019chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL全身影響一心血管系統(tǒng)38TourniquetpainoProlongedtourniquetinflationduringgeneralanaesthesiacausesincreasesinheartrateandbloodpressure,whichcommonlyleadtheanaesthetisttoincreasethedepthofanaesthesiathisclinicalsyndromeiscommonlyreferredtoastourniquetpain長時間止血帶充氣后,全麻患者出現(xiàn)心率、血壓上升。067%全麻患者發(fā)生tourniquetpaino與高齡、手術(shù)時長相關(guān),常發(fā)生在下肢手術(shù)ValliHRosenbergPH,KyttaJ,etal.Arterialhypertensionassociatedwiththeuseoftourniquetwitheithergeneralorregionalanaesthesia.ActaAnaesthesiol