腹盆腔手术的麻醉.pptx

第一节、腹、盆腔手术麻醉的特点1、腹、盆腔脏器的主要生理功能和围术期病理生理变化Theorgansinabdominalandpelviccavitiesincludedigestivesystemandgenitourinarysystem.Themainphysiologicalfunctionsaredigestion,absorption,metabolism,elimination,immunefunctionandsecretion.Theadequatepreoperativepreparationshouldbedonetoavoidanestheticcomplications.2、腹、盆腔手术围术期液体管理Severebleeding(massivehemorrhage),massivelossofbodyfluid,internalredistributionoffluids—oftencalled“thirdspace”cancausesevereintravasculardepletion.Thefluidsinfusionrateis10ml/kg/handthecrystalloidandcolloidsolutionsshouldbeadministeredproperly.Whenthedangerofanemiaoutweighstherisksoftransfusion,furtherbloodlossshouldbereplacedwithtransfusionofredbloodcellstomaintainhemoglobinconcentrationorhematocrit.3、手术体位(Patient’spositioninoperation）对生理功能的影响4、腹压对生理功能的影响Increasedabdominalpressureandelevationofdiaphragmleadtodyspnea.Anestheticagents,anesthetictechniquesandrapiddecompressionexacerbatevasodilatation,decreasedvenousreturntoheartandcardiacoutput.Themeasuresshouldbetaken:AdministrationofIVfluids.Modulatetheposition.Administrationofephedrine.Avoidrapiddecompression.5、腹、盆腔手术对肌松弛的要求Completeneuromuscularblockingisrequiredinoperations.6、腹、盆腔手术中的内脏牵拉反应Distensionofvisceraortractiononperitoneummayinducebradycardia,reducingofarterialpressureandcardiacarrest.VagusreflexionandpelvicnervesreflexionMesenterytractionsyndrome7、腹、盆腔急症手术的特点PreoperativeassessmentHistoryandphysicalexaminationFullstomachHypovolemiaFluidandelectrolytesdisturbanceAcid-baseunbalancePreparationforemergencyoperations第二节、腹、盆腔手术的常用麻醉方法一.局部麻醉（localanesthesia)二.椎管内麻醉（intravertebralanesthesia）三.全身麻醉（Generalanesthesia)四.全麻复合椎管内麻醉（Intravertebralanesthesiausedtosupplementgeneralanesthesia)常用于肝肾功能异常，手术操作复杂，手术时间冗长，术后需镇痛的大型手术.利用了两种麻醉方法各自的优点，避免了实施一种麻醉方法所具有的缺点.第三节常见腹盆腔手术的麻醉处理一、胃肠手术的麻醉（Anesthesiaforgastrointestinaloperations)胃肠手术的麻醉胃肠手术的麻醉胃肠手术的麻醉二、胆道手术的麻醉(anesthesiaforoperationsonbiliarytract)胆道手术的麻醉胆道手术的麻醉胆道手术的麻醉胆道手术的麻醉胆道手术的麻醉胆道手术的麻醉三、胰腺手术的麻醉（Anesthesiaforpancreassurgery)胰腺手术的麻醉胰腺手术的麻醉胰腺手术的麻醉四、肝手术的麻醉(Anesthesiaf