临床麻醉学教案全身麻醉期间严重并发症的防治

1、课程名称：临床麻醉学教材名称：临床麻醉学授课时间： 授课对象：麻醉专业教学内容：全身麻醉期间严重并发症的防治计划学时：8学时重点：呼吸道梗阻的几种类型及其处理措施；呼吸抑制的原因及处理措施；低血压与高血压的产生原因及防止；引起心肌缺血的原因及防止；术中知晓及预防；苏醒延迟的原因及治疗难点： 心肌供血的生理知识、体温调节教学目的：掌握呼吸道梗阻、呼吸抑制、低血压与高血压、心肌缺血、术中知晓及苏醒延迟的原因和治疗；熟悉低温与体温升高的原因及处理，咳嗽、呃逆、术后呕吐、及恶性高热的原因及防治；了解心肌供血的生理知识，体温调节，术后肺感染的原因、表现及治疗教学方法：启发式教学、理论联系实际教具（挂图幻

2、灯投影及cai等）：cai课件新内容新知识（注明来源及所占比例）：心肌缺血的原因、诊断及处理，术中知晓的原因及预防，恶性高热的诱因、诊断及处理；气道高反应性策略。来源于anesthesia、占10%外语关键词：general anesthesia、complications、respiratory obstruction、regurgitation and aspiration、hypertension、hypotension、awarenss、myocardic ischemia、laryngospasm and bronchospasm、malignant hyperthermia、hyp

3、othermia参考资料：现代麻醉学第三版、anesthesia（miller第六版）、国外医学麻醉学分册、内科学课 堂 设 计：导课、介绍重点 10 设问、讲解舌后坠 10分泌物、脓痰、血液、异物阻塞气道 5 cai、讲解、举例反流与误吸 15 cai、讲解、举例插管位置异常、管腔阻塞、麻醉机故障 5 cai、讲解、举例气管受压 5 cai、讲解、举例口咽腔炎性病变、喉肿物、过敏性喉水肿 5 cai、讲解、举例喉痉挛 10 cai、讲解、举例支气管痉挛 10 cai、讲解、举例中枢及外周性呼吸抑制 15 cai、讲解、举例呼吸抑制的呼吸管理 10 cai、讲解、举例低血压的概念及原因 15

4、cai、讲解、举例低血压的预防 15 cai、讲解、举例低血压的措施 10 cai、讲解、高血压的原因、预防及措施 20 cai、讲解、举例心肌缺血的有关生理知识 15 cai、讲解、心肌缺血的诊断方法 5 cai、讲解、麻醉期间引起心肌缺血的原因及防治 20 cai、讲解、举例机体的产热、散热及体温调节 15 cai、讲解、低体温 20 cai、讲解、举例体温升高 15 cai、讲解、举例术中知晓 15 cai、讲解、举例苏醒延迟的原因 20 cai、讲解、举例苏醒延迟的治疗 15 cai、讲解、举例咳嗽 15 cai、讲解、举例呃逆 5 cai、讲解、举例术后呕吐 10 cai、讲解、举例

5、术后肺感染的原因及临床表现 20 cai、讲解、举例术后肺感染的诊断及治疗 15 cai、讲解、恶性高热的原因及临床表现 20 cai、讲解、举例恶性高热的治疗 10 cai、讲解、总结 5 板书教 学 过 程：chapter 14prevention and treatment of serious complications during general anesthesiaintroduction：complications of anesthesia involve three aspects：patient's condition；diathesis of anestheti

6、st；influence and fault of anesthetics、anesthetic apparatus and correlated instrument respiratory obstruction（呼吸道梗阻）一、glossocoma（舌后坠）：最常见1aetiology（病因学）：2liability factor（易患因素）：justo major of corpus linguae（舌体过大）、short and stout（矮胖）、short neck（颈短）、lymphadenosis of throat posterior wal、hypertrophy of

7、tonsils（扁桃体肥大）3clinical features（表现）： 4management（措施）：side lying（侧卧）、head hypsokinesis（头后仰）、lift submaxilla（托下颌）、oropharyngeal and nasopharyngeal parichnos二、airway obstruction by secretion、purulent sputum、blood and foreign object1aetiology：inhalation of stimulant anesthetic，bronchiectasis（支气管扩张）、pul

8、monary abscess（肺脓肿）、pulmonary tuberculous cavity（肺结核空洞），operation of cavum nasopharyngeum（鼻咽腔）、oral cavity（口腔）、harelip（唇裂）手术，desquamation of tooth or artifcal teeth（牙或义齿脱落）2management：sufficient belladonna premedication（术前足量颠茄类药），intubation，suck respiratory tract，pull out dentium vacillatia or artif

9、cal teet三、regurgitation and aspiration（反流与误吸）：mortality 50%75%1aetiology：anticholinergic agent（抗胆碱药）、morphine、general anaesthetics、muscle relaxant2clinical features：bronchospasm（支气管痉挛），tachypnea and dyspnea（呼吸急促、困难），moist rales（湿罗音），sever hypoxia（严重缺氧）3management：（1）fasting（禁食、水）：adult：8h before ane

10、sthesiachildren：< 6m - milk and solid diet（4h），liquid（2h）636m - milk and solid diet（6h），liquid（3h）> 36m - milk and solid diet（8h），liquid（3h）（2）preoperative administration of an h2-receptor antagonist,such as cimetidine or ranitidine to decrease further secretion of additional acid.（3）applicati

11、on of gastric decompression by a wide-bore nasogastric tube; preparing for suction （4）full stomach/high level ileus：awake intubation whenever possible.（5）use of rapid - sequence induction and intubation without positive - pressure ventilation before intubation.（6）application of cricoid compression t

12、o control regurgitation of gastric contents.（7）extubation only when the patient is fully awake.（8）aspiration：head down position，suck vomitusbronchial antispasmodic and antibioticsrespiration supportlavage of trachea using 0.9%nacl四、malposition of catheter（插管位置异常）、ostruction of lumina（管腔堵塞）、anaesheti

13、c machine failure（麻醉机故障）1aetiology：catheter twist、block by sputum、corrugated tube twist、malfunction of respiration valve2management：examine position of catheter、respiratory sound，breathing circuit、respiration valve五、trachea compression（气管受压）1aetiology：tumour、mediastinum and edema calidum of neck or

14、mediastinum2management：六、inflamm affection of pharyngo-oral cavity（口咽腔炎症病变）、larynx tumer（喉肿物）、allergia laryngeal oedema（过敏性喉水肿）1aetiology：tumour、mediastinum and edema calidum of neck or mediastinum2management：七、laryngospasm and bronchospasm（喉痉挛与支气管痉挛）：（一）laryngospasm：1aetiology：pharyngeal vagus nerv

15、e excitability（咽部迷走神经兴奋性）2evoked reasons：（1）hyoxemia、hypercapnia、secretion、oropharynx parichnos、laryngoscope、intubation（2）light anesthesia：3clinical features：4management：5prevention：avoid light anesthesia，avoid hypoxia and carbon dioxide accumulation（二）bronchospasm：1aetiology： （1）tracheal intubation

16、、aspiration、suck sputum（2）operation stimulate（3）thiopental sodium、morphine2clinical features：3management：respiratory depression一、central respiratory depression1aetiology：anesthetics、narcotic analgesics、hyperventilation、inflate lung unduly2management：（1）anesthetics reduce depth of anesthesia（2）narcot

17、ic analgesics naloxone（3）hyperventilation、inflate lung undulyvt二、peripheral respiratory depression1aetiology：muscle relaxant，hypopotassemia，general anaesthesia + epidural block2management：（1）muscle relaxantneostigmine bromide（2）hypopotassemiasupply potassium in time（3）spinal nerve blockwait三、respira

18、tion management1effective ventilation2select of ventilation mode：assistor respiration or controlled respirationhypotention and hypertension（低血压与高血压）一、hypotension1hypotension：> 20% or 80mmhg2aetiology：（1）anesthesia aspects：（2）operation aspects：（3）patient aspects：3prevention：（1）insufficient body fl

19、uidsufficiently supply（2）sever anaemia（3）sever mitral valve stenosis（4）myocardial ischemiamaintain blood pressure（5）myocardial infarction（6）congestive heart failure（7）°bbb、sick sinus syndromepacemaker（8）hypopotassemia（9）atrial fibrilation80120 bpm（10）using long-term corticosteroid4management：（1）reduce depth of anesthesia（2）transfusion，pro re nata ephedrine（3）sever coronary heart diseaseto support cardiac pump function（4）drag internal organssto