復(fù)合麻醉與聯(lián)合麻醉醫(yī)學(xué)PPT課件

1、復(fù)合麻醉與聯(lián)合麻醉1復(fù)合麻醉(balanced anesthesia)及聯(lián)合麻醉（combined anesthesia)的定義復(fù)合麻醉的應(yīng)用原則靜吸復(fù)合麻醉與全憑靜脈麻醉的比較聯(lián)合麻醉的優(yōu)缺點(diǎn)2復(fù)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(shí)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(jī)體的應(yīng)激狀態(tài)維護(hù)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(fù)合麻醉的應(yīng)用原則合理的選擇麻醉藥物和劑量準(zhǔn)確地判斷麻醉深度加強(qiáng)麻醉管理優(yōu)化用藥方案堅(jiān)持個(gè)體化原則不同麻醉技術(shù)的聯(lián)合使用5臨床常用的復(fù)合麻醉方案1.靜吸復(fù)合麻醉Propofol+Fentanyl+Esmeron 誘導(dǎo)插管Sevoflurane+Remifentnil 維持2.全憑靜脈麻

3、醉（TIVA or TCI）Propofol+Fentanyl+Esmeron 誘導(dǎo)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(jì)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(shí)效敏感半衰期The CSHT of remifentanil is less than 5 minutes, independently of the time of administration.9Propofol時(shí)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(diǎn)可以達(dá)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(yīng)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(yīng)減少靜脈麻醉藥或吸入麻醉藥的應(yīng)用，病人術(shù)后蘇醒迅速、恢復(fù)快可以減少肌松藥的用量術(shù)后保留硬外導(dǎo)管，可以提供完善的術(shù)后鎮(zhèn)痛13硬外復(fù)合全麻的優(yōu)點(diǎn)14硬外復(fù)合全麻的優(yōu)點(diǎn)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