麻醉學在臨床醫(yī)學中的地位課件

1、麻醉學在臨床醫(yī)學中的地位麻醉學在臨床醫(yī)學中的地位麻醉學在臨床醫(yī)學中的地位麻醉學在臨床醫(yī)學中的地位麻醉學在臨床醫(yī)學中的地位麻醉學在臨床王祥瑞：教授（2006年），博士生導師?，F(xiàn)任醫(yī)學院麻醉及危重病系主任、仁濟醫(yī)院麻醉與危重病學教研室科主任、院黨委委員麻醉及危重病學 上海市精品課程1997,2007年上海交大醫(yī)學院優(yōu)秀教師教學獲獎情況 2008年上海交大醫(yī)學院優(yōu)秀教師團隊首席教師2王祥瑞：教授（2006年），博士生導師?，F(xiàn)任醫(yī)學院麻醉及危重上海交通大學醫(yī)學院教授委員會委員中國醫(yī)師學會麻醉分會委員中華醫(yī)學會急診分會危重病專家委員會常委華東危重病專家委員會常委上海醫(yī)學會麻醉學會副主任委員上海醫(yī)學會危重

2、病學會委員上海醫(yī)學會外科學會委員中華針灸學會針刺麻醉理事會秘書長兼理事上海針灸學會針刺麻醉分會副主任委員3上海交通大學醫(yī)學院教授委員會委員31. Wang XR, Xiao J, Sun DJ，Myocardial protective effects of electroacupuncture and hypothermia on porcine heart after ischemia/reperfusion. Acupunct Electrother Res. 2003;28(3-4):193-2002.Wang XR, Lin H, Wang ZH. Protective effect

3、s of electroacupuncture and Salviae Miltiorrhizae on myocardial ischemia/reperfusion in rabbits. Acupunct Electrother Res. 2003;28(3-4):175-823.D. S. SU, X. R. WANG, Y. J. ZHENG, Y. H. ZHAO and T. J. ZHANG. Retrograde cerebral perfusion of oxygenated, compacted red blood cells attenuates brain damag

4、e after hypothermia circulation arrest of rat. Acta Anaesthesiol Scand 2005; 49: 117211814.Xiang-rui Wang, Yong-jun Zheng, Jie Tian, Zheng-hong Wang and Zhi-ying Pan. A preliminary study on the monitoring of mixed venous oxygen saturation through the left main bronchus. Critical Care 2005, 10:R7-R13

5、5. Qi Fang LI Xiang Rui WANG Yue Wu YANG Han LIN. Hypoxia upregulates hypoxia inducible factor (HIF)-3alpha expression in lung epithelial cells: characterization and comparison with HIF-1alpha. Cell Res. 2006 Jun;16(6):548-586Ning QM, Wang XR。Activations of mitogen-activated protein kinase and nucle

6、ar factor-kappaB by mechanical stretch result in ventilation-induced lung injury. Med Hypotheses.2007，68:356-3607Su Dian-San, Wang Xiang-Rui, Zheng Yongjun, Zhao Yan-Hua. Low hematocrit worsens cerebral injury after prolonged hypothermic circulatory arrest in rats. CAN J ANESTH 2006 , 53( 12 ): 1220

7、12298. Li QF, Wang XR, Yang YW, Su DS. Up-regulation of Hypoxia Inducible Factor 1alpha by Isoflurane in Hep3B Cells. Anesthesiology. 2006 Dec;105(6):1211-12199、Ning QM, Wang XR.Response of Alveolar Type II Epithelial Cells to Mechanical Stretch and Lipopolysaccharide. Respiration. 2007;74(5):579-85

8、.第一和通訊作者發(fā)表SCI收錄文章21篇41. Wang XR, Xiao J, Sun DJ，Myo10.Activations of mitogen-activated protein kinase and nuclear factor-kappaB by mechanical stretch result in ventilation-induced lung injury. Med Hypotheses.2007，68:356-360 11Response of Alveolar Type II Epithelial Cells to Mechanical Stretch and Li

9、popolysaccharide. Respiration. 2007;74(5):579-85. 12.Dose-dependent neuroprotection of delta opioid peptide D-Ala2, D-Leu5 enkephalin in neuronal death and retarded behavior induced by forebrain ischemia in rats. Neurosci Lett. 2007;423(2):113-7 13Role of Rel A and IkappaB of nuclear factor kappaB i

10、n the release of interleukin-8 by cyclic mechanical strain in human alveolar type II epithelial cells A549. Respirology. 2007 Nov;12(6):792-8.14.Attenuating phosphorylation of p38 MAPK in the activated microglia: a new mechanism for intrathecal lidocaine reversing tactile allodynia following chronic

11、 constriction injury in rats. Neurosci Lett, 2008 Jan 31;431(2):129-34. 第一和通訊作者發(fā)表SCI收錄文章21篇510.Activations of mitogen-act15. Effects of intrathecal lidocaine on hyperalgesia and allodynia following chronic constriction injury in rats.Eur J Pain. 2009 Feb;13(2):130-7. Epub 2008 May 16. 16.Delta opioi

12、d agonist D-Ala2, D-Leu5 enkephalin (DADLE) reduced oxygen-glucose deprivation caused neuronal injury through the MAPK pathway. Brain Res. 2009 Oct 6;1292:100-6. 17. In reply to Is intrathecal lidocaine administration risk-free in rats with neuropathic pain?” Eur J Pain. 2009, 13(6):891 18.Activity

13、of sulfotransferase 1A1 is dramatically upregulated in patients with hepatocellular carcinoma secondary to chronic hepatitis B virus infection. Cancer Sci.2010 Feb;101(2):412-5. 19. Resection of the nerves bundle from the sphenopalatine ganglia tend to increase the infarction volume following middle

14、 cerebral artery occlusion.Neurol Sci.2010 Aug;31(4):431-5. 20 Lidocaine attenuates proinflammatory cytokine production induced by extracellular adenosine triphosphate in cultured rat microglia. Anesth Analg. 2010 Sep;111(3):768-74. 21. Time course of action and pharmacokinetics of ropivacaine in ad

15、ult and elderly patients following combined lumbar plexus-sciatic nerve block. Int J Clin Pharmacol Ther. 2010 Sep;48(9):608-13. 第一和通訊作者發(fā)表SCI收錄文章21篇615. Effects of intrathecal li醉飲酒過量，神志不清。沉迷；過分愛好：醉心“酉” （yu）表示酒,“卒”表示終結。酒喝到不能再喝的時候,就醉了 麻 醉 Anesthesia7醉“酉” （yu）表示酒,“卒”表示終結。酒喝到不能再喝的沉醉不知歸路 -宋 李清照如夢令 8沉醉不知

16、歸路 8醉里吳音相媚好 -宋 辛棄疾清平樂村居 醉能同其樂,醒能述以文者-宋 歐陽修醉翁亭記 9醉里吳音相媚好 醉能同其樂,醒能述以文者9 麻醉 用藥物或針刺使肌體暫時喪失知覺 10 麻醉 10古代麻醉學11古代麻醉學11在十九世紀四十年代，西方的手術通常都是伴著被皮帶綁在手術臺上的病人的痛苦哀嚎和掙扎簡單的麻醉手段，喝醉可以使他們失去知覺，惡心，嘔吐甚至酒精中毒魯莽的醫(yī)生試過用拳頭或者榔頭把病人錘昏。這些方法都殘忍而且不可靠12在十九世紀四十年代，西方的手術通常都是伴著被皮帶綁在手術臺上現(xiàn)代麻醉學歷史 HistoryWilliam Morton ether demonstration (in

17、 1846)More than 1500 years ago, used some herbs and alcoholAnesthesia as a discipline(branch of knowledge)13現(xiàn)代麻醉學歷史 HistoryWilliam Morton 1846年10月16日,美國麻省總醫(yī)院Bulfinch住院大樓頂層的圓形手術示教室里有一場精彩的手術表演正準備上演,示教室里坐滿了充滿好奇及懷疑的醫(yī)學專家、普通醫(yī)師及醫(yī)學生。主刀醫(yī)師是當時著名的外科醫(yī)師John Collins Warren,將對一名名叫Gilbert Abbott的畫家行下頜部血管瘤切除術。但表演由于一個

18、人的遲到還未開始,這個人名叫William T.G. Morton,是一名牙科醫(yī)師歷史 History141846年10月16日,美國麻省總醫(yī)院Bulfinch住院大當時手術及難以忍受的疼痛緊密相隨Morton帶來一個由圓形玻璃容器以及與它相連的管子組成的裝置,玻璃容器中裝有一些被浸泡過的海綿術始 Morton 將管子遞給患者,讓其吸入玻璃容器里的東西。4-5min后,患者熟睡著了Warren醫(yī)師很順利地切下了血管瘤，患者未出現(xiàn)出現(xiàn)的痛苦掙扎和哭喊蘇醒之后,Abbott告訴周圍好奇的人們,整個過程并未感覺到疼痛Warren醫(yī)師:“先生們,這不是欺騙(Gentlemen, this is no

19、humbug)”。隨著這句名言的誕生了一個嶄新的醫(yī)學時代15當時手術及難以忍受的疼痛緊密相隨15急救與復蘇（first-aid and resuscitation)疼痛治療（Pain management)臨床麻醉(Clinical anesthesia)重癥治療（Intensive care）麻醉學范疇16急救與復蘇（first-aid and resuscitat臨床麻醉 Clinical anesthesia保證手術、診斷及治療順利進行麻醉藥物麻醉方法意識喪失或手術部位無痛完全恢復17臨床麻醉 Clinical anesthesia保證手術、診重癥醫(yī)學The intensive ther

20、apy unit(一)急性、可逆、危及生命的器官或系統(tǒng)功能衰竭，經(jīng)嚴密監(jiān)治短期內(nèi)可能得到恢復(二)存在各種高危因素，具有潛在生命危險，經(jīng)過嚴密的監(jiān)治可能減少死亡風險(三)慢性器官或者系統(tǒng)功能不全出現(xiàn)急性加重且危及生命，經(jīng)嚴密監(jiān)治可能恢復到原來或接近原來狀態(tài)The highest level of continuous patient care and treatment18重癥醫(yī)學The intensive therapy unitManagement of painPain clinicsPostoperative pain controlCancer Pain management19Ma

21、nagement of painPain clinics2020Cardiopulmonary resuscitationCommonly after cardiac arrest, respiratory arrest or two combination of the twoCPR is required when the supply of oxygen to the brain is insufficient to maintain function21Cardiopulmonary resuscitation21世紀麻醉學走向何方？中華醫(yī)學會麻醉分會新提出的麻醉科發(fā)展目標引領舒適化醫(yī)療發(fā)展的主導學科保障醫(yī)療安全的關鍵學科搶救生命技能和理論的特殊學科提高醫(yī)院整體效率的學科協(xié)調(diào)各科室的中心學科