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1、胳划习措恩赊芹厉止雇袋鸭醋依汇烦滥咯爸栏与撵空唬夕答幢讯铸暗婚锰临床麻醉学临床麻醉学临床麻醉学临床麻醉学Clinical AnesthesiologyClinical Anesthesiology绪论绪论IntroductionIntroduction The The term term “anesthesia“anesthesia( ( 麻麻麻麻醉醉醉醉) ) is is derived derived from from Greek Greek Word, Word, it it means means “lack “lack of of feeling feeling or or sen
2、sation sensation or“privation of senses or“privation of senses im plying im plying lack lack of of appreciation. appreciation. The The usual usual concept concept for for anesthesia anesthesia relates relates primarily primarily to to the the prevention prevention of of pain pain perception percepti
3、on during during an an operation operation or or an an invasive invasive procedure procedure . . But But , , this this concept concept is is out out of of date now.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胳划习措恩赊芹厉止雇袋鸭醋依汇烦滥咯爸栏与撵空唬夕答幢讯铸暗婚锰临床麻醉学临床麻醉学 In general , anesthesia can be defined as
4、a drug-induced or physical factors-induced state of reversible functional depression of 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 The The increasing increasing c
5、omplex complex nature nature of of operations operations sparked sparked the the development development of of anesthesia anesthesia . . Advance Advance in in related related basic basic science science especially especially in in research research in in anesthesia anesthesia per per se se ,and ,and
6、 the the development development of of new new agents agents ,adjuvants ,adjuvants , , eguipments, eguipments, technigues technigues and and capacity capacity of of sustaining sustaining life life had had changed changed and and broadened broadened anesthesia anesthesia into into a a discipline disc
7、ipline concerned concerned with with more more than than relief relief of of pain pain . . over over the the past past 56 56 decades decades ,anesthesiology(,anesthesiology(麻麻麻麻醉醉醉醉学学学学) ) has has emerged emerged as as a clearly defined specialty and firmly established .a clearly defined specialty a
8、nd 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胳划习措恩赊芹厉止雇袋鸭醋依汇烦滥咯爸栏与撵空唬夕答幢讯铸暗婚锰临床麻醉学临床麻醉学 The evolution of modern anesthesiology may be The evolution of modern anesthesiology may be devided into 3 stages :devided into 3 stages : 1 1、麻醉、麻醉、麻醉、麻醉anesthesiaanesthesia 2 2、临床麻醉学、临床麻醉学、临
9、床麻醉学、临床麻醉学(Clinical anesthesiology)(Clinical anesthesiology) 3 3、麻醉与危重病医学、麻醉与危重病医学、麻醉与危重病医学、麻醉与危重病医学(anesthesiology and (anesthesiology and critical care medicine)critical care medicine) department of anesthesiology and resuscitation department of anesthesiology and resuscitation department of anest
10、hesiology and critical care department of anesthesiology and critical care medicine . 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一、麻醉学开展简史一、麻醉学开展简史一、麻醉学开展简史一、麻醉学开展简史(The history of anesthesia )(The history of anesthesia )1 1、Ancient times Ancient times 1 1Acupuncture analgesia Acupuncture
11、analgesia 475221 475221 B.C.B.C. 2 2华陀华陀华陀华陀(141203 )(141203 )麻沸散麻沸散麻沸散麻沸散 3 3Ancient Egyptians used The combination of Ancient Egyptians used The combination of opium poppy and hyoscyamus opium poppy and hyoscyamus 4 4The Incas may be the earliest to use local The Incas may be the earliest to use l
12、ocal anesthesia .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2 2、Modern anesthesiology Modern anesthesiology 1 1Inhalational Anesthesia (Inhalational Anesthesia (吸入麻醉吸入麻醉吸入麻醉吸入麻醉) ) 1844 Horace wells N2 0 ( 1844 Horace wells N2 0 (氧化亚氮氧化亚氮氧化亚氮氧化亚氮) ) 1846 William T.G. Morton Ether ( 1846 W
13、illiam T.G. Morton Ether (乙醚乙醚乙醚乙醚) ) 1847 James Simpson chloroform( 1847 James Simpson chloroform(氯仿氯仿氯仿氯仿) ) 1920 Arthur E. Guedel was the first to elaborate 1920 Arthur E. Guedel was the first to elaborate on the signs of general anesthesia on the signs of general anesthesia Magill Endotracheal i
14、ntubation ( Magill Endotracheal intubation (气管内插管气管内插管气管内插管气管内插管) )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1927 Ralph waters sodalime (钠石灰钠石灰) 1956 halothane (氟烷氟烷) 1972 enflurane (恩氟烷恩氟烷) 1981 isoflurane (异氟烷异氟烷) 1990 sevoflurane (七氟烷七氟烷) 1992 desflurane (地氟烷地氟烷)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
15、麻醉学临床麻醉学2 2Intravenous anesthesia (Intravenous anesthesia (静脉麻醉静脉麻醉静脉麻醉静脉麻醉) ) 1934 Lundy 1934 Lundy 和和和和waters thiopental (waters thiopental (硫喷妥钠硫喷妥钠硫喷妥钠硫喷妥钠) ) benzodiazepines ( benzodiazepines ( 苯二氮卓类药苯二氮卓类药苯二氮卓类药苯二氮卓类药 ) ) diazepam diazepam 地西泮地西泮地西泮地西泮 1959 1959 midazolam ( midazolam (咪达唑仑咪达唑仑
16、咪达唑仑咪达唑仑) 1976) 1976 others: others: sodium hydroxybutyrate , r-oH ( sodium hydroxybutyrate , r-oH (羟丁酸钠羟丁酸钠羟丁酸钠羟丁酸钠)1960)1960 ketamine ( ketamine (氯胺酮氯胺酮氯胺酮氯胺酮) 1970) 1970 etomidate ( etomidate (依托咪酯依托咪酯依托咪酯依托咪酯) 1972) 1972 propofol (propofol (丙泊酚丙泊酚丙泊酚丙泊酚) 1983) 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
17、纹临床麻醉学临床麻醉学(3) opioids fentanyl (芬太尼芬太尼) sufentanil (舒芬太尼舒芬太尼) alfentanil (阿芬太尼阿芬太尼) remifentanil (瑞芬太尼瑞芬太尼)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(4) Muscle Relaxants (4) Muscle Relaxants (肌肉松弛药肌肉松弛药肌肉松弛药肌肉松弛药) ) 1942 curare ( 1942 curare (箭毒箭毒箭毒箭毒) ) Succinylcholine ( Succinylcholine (琥珀胆缄琥珀胆缄琥
18、珀胆缄琥珀胆缄) ) Mivacurium ( Mivacurium (米库氯铵米库氯铵米库氯铵米库氯铵) ) Now , the relaxants in common use include Now , the relaxants in common use include Vecuronium (Vecuronium (维库溴铵维库溴铵维库溴铵维库溴铵), atracurium (), atracurium (阿屈库铵阿屈库铵阿屈库铵阿屈库铵) ) Rocuronium ( Rocuronium (罗库溴铵罗库溴铵罗库溴铵罗库溴铵) ) Cisatracuronium ( Cisatra
19、curonium (顺式阿屈库铵顺式阿屈库铵顺式阿屈库铵顺式阿屈库铵) )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5 5Local and Regional anesthesia (Local and Regional anesthesia (局麻和区域麻局麻和区域麻局麻和区域麻局麻和区域麻醉醉醉醉) ) 1884 Carl koller topical cocaine ( 1884 Carl koller topical cocaine (可卡因表麻可卡因表麻可卡因表麻可卡因表麻) ) 1898 August Bier spinal anesthe
20、sia ( 1898 August Bier spinal anesthesia (脊麻、腰脊麻、腰脊麻、腰脊麻、腰麻麻麻麻) ) 1901 Ferdinand cathelin and Jean sicard 1901 Ferdinand cathelin and Jean sicard caudal epidural anesthesia (caudal epidural anesthesia (骶麻骶麻骶麻骶麻) ) 1921 Fidal pages and 1931 Achille Dogliotti 1921 Fidal pages and 1931 Achille Dogliott
21、i Lumbar epidural anesthesia (Lumbar epidural anesthesia (腰部硬膜外麻醉腰部硬膜外麻醉腰部硬膜外麻醉腰部硬膜外麻醉) )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1904 Alfred Einhorn synthesized procaine1904 Alfred Einhorn synthesized procaineOther local anesthetics:Other local anesthetics: dibucaine( dibucaine(地布卡因，地布卡因，地布卡因，地布卡因
22、，1930)1930)，tetracaine(tetracaine(丁卡因丁卡因丁卡因丁卡因 1932) 1932) lidocaine(lidocaine(利利利利多多多多卡卡卡卡因因因因，1932)1932)，chloroprocaine(chloroprocaine(氯氯氯氯普普普普鲁鲁鲁鲁卡卡卡卡因因因因,1955),1955) mepivacaine(mepivacaine(甲甲甲甲 哌哌哌哌 卡卡卡卡 因因因因 ,1957),prilocaine(,1957),prilocaine(丙丙丙丙 胺胺胺胺 卡卡卡卡 因因因因,1960),1960) bupivacaine(bupiva
23、caine(布布布布 比比比比 卡卡卡卡 因因因因 ,1963),etidocaine(,1963),etidocaine(依依依依 替替替替 卡卡卡卡 因因因因,1972),1972) The latest local anesthetics include ropivacaine(The latest local anesthetics include ropivacaine(罗哌卡罗哌卡罗哌卡罗哌卡 因因因因)and levobupivacaine()and levobupivacaine(左旋布比卡因左旋布比卡因左旋布比卡因左旋布比卡因) )刮潮副善绽萧悲汲硒赌霓犬汤惩遍燥煮麦滞额上竣
24、蔡结盛萝爷呢御卖朝警临床麻醉学临床麻醉学Anesthesiologist prof Rovenstine established the first pain clinic1970 In USA, society of critical care medicine formed(美国危重病学会成立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(6)Since the eighties of last century until now the clinical anesthesiology is characterized by em
25、phasizing anesthetic monitoring and paying more attention to anesthetic safety.The minimum standards for intraoperative monitoring have beenadopted by the ASA (American society of Anesthesiologists) 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Body temperature(体温体温 )Arterial blood pressureand h
26、eart rateElectrocardiography (ECG) (心电图心电图)Pulse oximetry (SPO2，脉搏氧饱和度，脉搏氧饱和度)End tidal carbon dioxide (呼气末二氧化碳呼气末二氧化碳)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二麻醉学专业的任务和范围二麻醉学专业的任务和范围二麻醉学专业的任务和范围二麻醉学专业的任务和范围(The scope and task of
27、 Anesthesiology)(The scope and task of Anesthesiology)The scope and basic tasks of anesthesiology include:The scope and basic tasks of anesthesiology include:1.Clinical anesthesiology1.Clinical anesthesiology(1).To perform preanesthetic visit and evalualion , (1).To perform preanesthetic visit and e
28、valualion , and to formulate anesthetic plan. Taking part in and to formulate anesthetic plan. Taking part in the preanesthelic preparation.the preanesthelic preparation.(2).To render patients insensible to pain and (2).To render patients insensible to pain and discomfort and keep the stress respons
29、ediscomfort and keep the stress response at suitable at suitable level.level.甫侵晾厂贫啸午浩鹿赣灶申粘归杨庚缸黔航弧昼嗣串智娜威卤心漓筛尘告临床麻醉学临床麻醉学(3).To (3).To monitor monitor the the patients patients during during operations,and operations,and to regulateto regulateor or control control the the importaut importaut physiolog
30、ical physiological functions functions of of the the patients patients in in order order to to provide provide maximum maximum safety safety for for the the patients patients and and to to provide optimal operative conditions for surgeons.provide optimal operative conditions for surgeons.(4).To prev
31、ent and treat anesthetic complications(4).To prevent and treat anesthetic complications(5).To (5).To monitor monitor and and treat treat patients patients in in postanesthesia postanesthesia care unit (PACU)care unit (PACU)邦殉董诞值钳岛孰癸喝车膜铣烫衰暂砒浇缄鼓回案绒巩碉案膘熟检傈肋瞒临床麻醉学临床麻醉学2.First aid and resuscitation(2.Fir
32、st aid and resuscitation(急救与复苏急救与复苏急救与复苏急救与复苏) )3.Critical care medicine (CCM,3.Critical care medicine (CCM,危重病医学危重病医学危重病医学危重病医学) )(intensive care medicine,(intensive care medicine,也称加强医学也称加强医学也称加强医学也称加强医学) )Its clinical position is called Intensive care unit, Its clinical position is called Intensi
33、ve care unit, ICU (ICU (重症监测治疗病室或加强医疗病室重症监测治疗病室或加强医疗病室重症监测治疗病室或加强医疗病室重症监测治疗病室或加强医疗病室) )4.Pain management and its relatcd researeh epically 4.Pain management and its relatcd researeh epically the mechanism of painthe mechanism of pain5.Research ,teaching and training5.Research ,teaching and training鉴
34、却彰盟若迪饭镰终金边清挥孜竞周椽者堡戈街莎睡去炯榜桔虞锦张军忱临床麻醉学临床麻醉学三如何学好麻醉学三如何学好麻醉学(How to learn anesthesiology)1.To 1.To combine combine basic basic medical medical sciences sciences with with clinical clinical medicine(medicine(根底与临床结合根底与临床结合根底与临床结合根底与临床结合) )2.To combine theory with practice (2.To combine theory with pract
35、ice (理论与实践结合理论与实践结合理论与实践结合理论与实践结合) )Anesthesiologist on paper; craftsman of anesthesiaAnesthesiologist on paper; craftsman of anesthesia3.To 3.To learn, learn, to to investigate investigate continuously; continuously; and and to to make make progress continuously.progress continuously.障咯奸带驹奶笆铂争掸邯恍附江
36、搭烂媒覆涎拓珐碾瓷弱鸯律癣筹阁英咙幸临床麻醉学临床麻醉学四麻醉的分类四麻醉的分类(classifications of anesthesia)1.classification of anesthetic technigues1.classification of anesthetic technigues( (按麻醉方法分类按麻醉方法分类按麻醉方法分类按麻醉方法分类) ) In a broad sense all types of anesthesia may be In a broad sense all types of anesthesia may be classified as ei
37、ther regional or general. But, in China, classified as either regional or general. But, in China, because of the wide usage andbecause of the wide usage and characteristic characteristic theoritical basis of epidural and spinal anesthesia, theoritical basis of epidural and spinal anesthesia, they ar
38、e put into an independent class called they are put into an independent class called “intravertebral anesthesia“intravertebral anesthesia. .淡奏蛤饺刚影切筷耸唤军盘古遵摄兜狐升瘤它陇负调光锚浸诵栋且蔑邮涎临床麻醉学临床麻醉学Anesthetic technigue may be classified as follows: General anesthesia(全身麻醉全身麻醉) .inhalational anesthesia (吸入麻醉吸入麻醉) .i
39、ntravenous anesthesia (静脉麻醉静脉麻醉) .intramuscular anesthesia(肌肉麻醉肌肉麻醉) .rectal anesthesia (直肠麻醉直肠麻醉) 肋于遗介尉铱魏骄祷酪警盆形盔鲤尝光彝败血现姑署靠繁粟惫蹈喘忻捌诀临床麻醉学临床麻醉学 Lntravertebral anesthesiaLntravertebral anesthesia( (椎管内麻醉椎管内麻醉椎管内麻醉椎管内麻醉) ) .subarachnoid block ( .subarachnoid block (蛛网膜下隙阻滞蛛网膜下隙阻滞蛛网膜下隙阻滞蛛网膜下隙阻滞) ) (spina
40、l anesthesia, (spinal anesthesia,脊麻脊麻脊麻脊麻. .腰麻腰麻腰麻腰麻) ) epidural block ( epidural block (硬脊膜外隙阻滞硬脊膜外隙阻滞硬脊膜外隙阻滞硬脊膜外隙阻滞) ) Some times subarachnoid block and epidural Some times subarachnoid block and epidural block areblock are also called “neuraxial anesthesia also called “neuraxial anesthesia( (神经轴麻
41、醉神经轴麻醉神经轴麻醉神经轴麻醉) ) 话说占楼拧氰疲碍痕而尝肆盖淑标秤亢蒋雪佳驾任如腹锦阎傅魏昧耙赦扮临床麻醉学临床麻醉学Local anesthesiaLocal anesthesia( (局部麻醉局部麻醉局部麻醉局部麻醉) ) topical anesthesia topical anesthesia( (外表麻醉外表麻醉外表麻醉外表麻醉) ) local infiltration local infiltration( (局部浸润麻醉局部浸润麻醉局部浸润麻醉局部浸润麻醉) ) field block field block 区域术野阻滞区域术野阻滞区域术野阻滞区域术野阻滞 (perip
42、heral) nerve blocks (peripheral) nerve blocks( (周围神经阻滞周围神经阻滞周围神经阻滞周围神经阻滞, ,神经阻滞神经阻滞神经阻滞神经阻滞) ) intravenous regional anesthesia intravenous regional anesthesia( (静脉局部麻醉静脉局部麻醉静脉局部麻醉静脉局部麻醉) ) In some textbooks and monographs, nerve blocks, spinal In some textbooks and monographs, nerve blocks, spinal a
43、nesthesia and epidural anesthesia are collectively called anesthesia and epidural anesthesia are collectively called “regional blook “regional blook or “regional anesthesia or “regional anesthesia 癸钵礼恍两戊毡贷厂头低坐期襟型疵妇淀慰岳硬峰牧贱别圾诗舞药撵那他临床麻醉学临床麻醉学Everyday expressions or terms in common use;balanced anesthes
44、ia(复合麻醉复合麻醉)combined anesthesia (联合麻醉联合麻醉)basal narcosis(根底麻醉根底麻醉endotracheal anesthesia(气管内麻醉气管内麻醉)endotracheal intubation(气管内麻醉气管内麻醉)endoBronchial anesthesia (支气管内麻醉支气管内麻醉)纺勤被疯杜钧桓么黄腰钒霜拍轴蝎淹玫怒毋早恃匣戊纶染墨其危宋尺较证临床麻醉学临床麻醉学2.1 2.1 classifications classifications according according to to the the subspecial
45、ty subspecialty of of clinical clinical anesthesiology anesthesiology ( (接接接接临临临临床床床床麻麻麻麻醉醉醉醉亚亚亚亚学学学学科科科科分分分分类类类类) ) such as:. such as:. anesthesia for cardiac surgeryanesthesia for cardiac surgery ( (心脏手术麻醉心脏手术麻醉心脏手术麻醉心脏手术麻醉) )anesthesia for Vascular surgeryanesthesia for Vascular surgery ( (血管外科手术
46、麻醉血管外科手术麻醉血管外科手术麻醉血管外科手术麻醉) )anesthesia for thoracic surgeryanesthesia for thoracic surgery( (胸科手术麻醉胸科手术麻醉胸科手术麻醉胸科手术麻醉) )neurosurgical anesthesianeurosurgical anesthesia( (颅脑外科麻醉颅脑外科麻醉颅脑外科麻醉颅脑外科麻醉) )anesthesiaanesthesia for organ transplantation for organ transplantation( (器官移植手术麻醉器官移植手术麻醉器官移植手术麻醉器官
47、移植手术麻醉) )企搂塘磷锚歼壳藉粤参蠕蚤料潞筛腊歧挑狡雍淫赏廓珊盗吸劳琉帚鹊颖辗临床麻醉学临床麻醉学anesthesia for endocrine surgery(anesthesia for endocrine surgery(内分泌外科麻醉内分泌外科麻醉内分泌外科麻醉内分泌外科麻醉) )obstetric anesthesiaobstetric anesthesia( (产科麻醉产科麻醉产科麻醉产科麻醉) )pediatric anesthesiapediatric anesthesia( (小儿麻醉小儿麻醉小儿麻醉小儿麻醉) )geriatric anesthesiageriatri
48、c anesthesia( (老年人麻醉老年人麻醉老年人麻醉老年人麻醉) )anesthesia for orthopedic surgeryanesthesia for orthopedic surgery( (骨科麻醉骨科麻醉骨科麻醉骨科麻醉) )anesthesia for abdominal sugeryanesthesia for abdominal sugery( (腹部外科麻醉腹部外科麻醉腹部外科麻醉腹部外科麻醉) )anesthesia for traumaanesthesia for trauma( (创伤外科麻醉创伤外科麻醉创伤外科麻醉创伤外科麻醉) )and so onand so on谁窜怂老蚂冗呈玖也椿檬通俭咱线锯啄匣注轻展内议窝胶俱策投浚柬砰天临床麻醉学临床麻醉学 2.2 classifcalions according to the subspecialty of anesthesiology (按麻醉学的亚学科分类按麻醉学的亚学科分类) clinical anesthesiology critical care medicine pain management流梳狮撅壬蕉宅冈雌谎贿煽收欲碎侗配辐敞液杂蹿佳己虚水么拈涣暴放碉临床麻醉学临床麻醉学
