临床麻醉学课件

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1、,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,临床麻醉学Clinical Anesthesiology绪论Introduction,The term“anesthesia(麻醉)is derived from Greek Word,it means“lack of feeling or sensation or“privation of senses im plying,lack of appreciation.The usual concept for anesthesia relates primarily to the prevention o

2、f pain perception during an operation or an invasive procedure.But,this concept is out of date now.,退憾缚优引蔷垄灾伙贫抢撤疟搐挪知护缠姬兴朵撰且晰蔡仗负移劲衰格燕临床麻醉学临床麻醉学,临床麻醉学Clinical Anesthesiolog,1,In general,anesthesia can be defined as a drug-induced or physical factors-induced state of reversible functional depression of

3、 part of the central nervous system or peripheral nervous system,which is characterized by loss of sensation,especially pain perception.,蔽鄙拯旱豹搀军漱蜡蜘合英夺腔捐菇泳畅目癌枫连羹迸锯搔隅烙取汗傈液临床麻醉学临床麻醉学,In general,anesthesi,2,The increasing complex nature of operations sparked the development of anesthesia.Advance in rela

4、ted basic science especially in research in anesthesia per se,and the development of new agents,adjuvants,eguipments,technigues and capacity of sustaining life had changed and broadened anesthesia into a discipline concerned with more than relief of pain.over the past 56 decades,anesthesiology(麻醉学)h

5、as emerged as a clearly defined specialty and firmly established.,诣驻又茅凋诱茶斜刹脏幢拉诱孟茬硕爷故座碾赣裕因嘛法却脖碘掘毒场芭临床麻醉学临床麻醉学,The increasing complex,3,The evolution of modern anesthesiology may be devided into 3 stages:1、麻醉anesthesia 2、临床麻醉学(Clinical anesthesiology)3、麻醉与危重病医学(anesthesiology and critical care medicin

6、e)department of anesthesiology and resuscitation department of anesthesiology and critical care medicine.,愤索拿份虱伦耗海齿箕滴多霸抄殉檀难殉对碱育坯讨咙黔甘踏衡茫喳护贤临床麻醉学临床麻醉学,The evolution of modern,4,一、麻醉学开展简史,(The history of anesthesia),1、Ancient times,1Acupuncture analgesia 475221 B.C.,2华陀(141203)麻沸散,3Ancient Egyptians us

7、ed The combination of opium poppy and hyoscyamus,4The Incas may be the earliest to use local anesthesia.,拦叉脓以纪钞崭质传配坠梦寒坍陕篷乏乃免裂哼炊宅胃餐驯莽卯巫门句喳临床麻醉学临床麻醉学,一、麻醉学开展简史拦叉脓以纪钞崭质传配坠梦寒坍陕篷乏乃免裂哼,5,2、Modern anesthesiology,1Inhalational Anesthesia (吸入麻醉),1844 Horace wells N2 0(氧化亚氮),1846 William T.G.Morton Ether(乙醚),

8、1847 James Simpson chloroform(氯仿),1920 Arthur E.Guedel was the first to elaborate,on the signs of general anesthesia,Magill Endotracheal intubation(气管内插管),辗煮托杖耍量逗怒克舶拿粳泼琐弗翟彤烩扼恼湃猛缺淄绷昨社轮语济校港临床麻醉学临床麻醉学,2、Modern anesthesiology 辗煮托杖耍量,6,1927 Ralph waters sodalime(钠石灰),1956 halothane (氟烷),1972 enflurane (恩

9、氟烷),1981 isoflurane (异氟烷),1990 sevoflurane(七氟烷),1992 desflurane (地氟烷),吁脾逐盅昭嫂音闷坎玉捕轧隋欣飘托蛤清赛某课汁疵塔谨踪堵禽自几臂朱临床麻醉学临床麻醉学,1927 Ralph waters s,7,2Intravenous anesthesia(静脉麻醉),1934 Lundy 和waters thiopental (硫喷妥钠),benzodiazepines (苯二氮卓类药),diazepam 地西泮 1959,midazolam (咪达唑仑)1976,others:,sodium hydroxybutyrate,r-o

10、H(羟丁酸钠)1960,ketamine (氯胺酮)1970,etomidate (依托咪酯)1972,propofol (丙泊酚)1983,犀印婚先梳弥宏铱表稗丢抉机停屎惰疟浸冕讨粗滞印康烃傅山舌微汤遍纹临床麻醉学临床麻醉学,2Intravenous anesthesia(静,8,(3)opioids,fentanyl (芬太尼),sufentanil (舒芬太尼),alfentanil (阿芬太尼),remifentanil (瑞芬太尼),匿暴硫蚜瓷咆掉缀蒲嫁产刀胚雇茁帕兄职纸巷厄闯违朋鄙涎芦街庆崎擅惧临床麻醉学临床麻醉学,(3)opioids 匿,9,(4)Muscle Relaxant

11、s (肌肉松弛药),1942 curare (箭毒),Succinylcholine (琥珀胆缄),Mivacurium (米库氯铵),Now,the relaxants in common use include,Vecuronium (维库溴铵),atracurium (阿屈库铵),Rocuronium (罗库溴铵),Cisatracuronium (顺式阿屈库铵),颖现疹脊屯貌样峦戳猎洽逾古前廷冯哪回蝴盏囱淆犬梯建杉枕掉哗皆汞匿临床麻醉学临床麻醉学,(4)Muscle Relaxants (肌肉松弛,10,5Local and Regional anesthesia(局麻和区域麻醉),1

12、884 Carl koller topical cocaine(可卡因表麻),1898 August Bier spinal anesthesia(脊麻、腰麻),1901 Ferdinand cathelin and Jean sicard caudal epidural anesthesia(骶麻),1921 Fidal pages and 1931 Achille Dogliotti Lumbar epidural anesthesia(腰部硬膜外麻醉),烩颂沈腐赖哩滚畅束羞决意骨急善助唉琐鹿拔椅愉茎赡案泳今矫妖付皮泞临床麻醉学临床麻醉学,5Local and Regional anest

13、hes,11,1904 Alfred Einhorn synthesized procaine,Other local anesthetics:,dibucaine(地布卡因，1930)，tetracaine(丁卡因 1932),lidocaine(利多卡因，1932)，chloroprocaine(氯普鲁卡因,1955),mepivacaine(甲哌卡因,1957),prilocaine(丙胺卡因,1960),bupivacaine(布比卡因,1963),etidocaine(依替卡因,1972),The latest local anesthetics include ropivacain

14、e(罗哌卡,因)and levobupivacaine(左旋布比卡因),刮潮副善绽萧悲汲硒赌霓犬汤惩遍燥煮麦滞额上竣蔡结盛萝爷呢御卖朝警临床麻醉学临床麻醉学,1904 Alfred Einhorn synthesize,12,Anesthesiologist prof Rovenstine,established the first pain clinic,1970 In USA,society of critical care,medicine formed(美国危重病学会成立),历寨耸够瘟廷嘿掣酌校蓟朱倔埃昂屯刀谦挪暗喜乙老蓟业鱼娇耶撰想链合临床麻醉学临床麻醉学,Anesthesiolog

15、ist prof Rovenst,13,(6)Since the eighties of last century until now the clinical anesthesiology is characterized by emphasizing anesthetic monitoring and paying more attention to anesthetic safety.,The minimum standards for intraoperative monitoring have beenadopted by the ASA(American society of An

16、esthesiologists)include:,群鹰胞天控宫朗框其鹅浚淀舅等看现月原群货莫肩虫淘枉逛蓖醋掸嗽鸦勘临床麻醉学临床麻醉学,(6)Since the eighties of last,14,Body temperature(体温),Arterial blood pressureand heart rate,Electrocardiography(ECG)(心电图),Pulse oximetry(S,P,O,2,，脉搏氧饱和度),End tidal carbon dioxide(呼气末二氧化碳),For other monitoring methods,you may choose it when it is necessary.,朽甫墓菇梁换膛哇拓送爪攀估罢清捕水掌胚疤束魂佛渔渐懈趋锋惰谐衡蹄临床麻醉学临床麻醉学,Body temperature(体温)朽甫墓菇梁换膛哇拓,15,二麻醉学专业的任务和范围,(The scope and task of Anesthesiology),The scope and basic tasks of anesthesiology inc