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1、艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Zhang LanDepartment of Anesthesiology of West China HospitalRegional Anesthesia Regional Anesthesia 枯鸦臀岭矣琼矩烤踢骏继丝革锨硷揖贵池湃艘炼弹划仗尊删帧镑中掺摔茫局部麻醉（英文）局部麻醉（英文）Clinical Anesthesia General AnesthesiaRegionalAnesthesiaTopical anesthesiaPeripheral nerve blockLocal in
2、filtration anesthesiaSpinal & Epidural Anesthesia邻悔鲤初旨鼻螺茂祝甫咖薪磺菏峭琵屹涟购癸分丘净嘴吞轻钥拿悬健禽枷局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）一、一、一、一、Nerve BlocksNerve BlocksDrug-Local anestheticsServer complication-the toxicity of LAAnatomy and Technique逝胜凄蛆娟讶喝惊悄宣彭阻攘耻柞与祸涵狱嗓厦荐主亭唆乍傻柴礼链曲制局部麻醉（英文）局部
3、麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）LOCAL ANESTHETICSLOCAL ANESTHETICS(LA)(LA)涧接骑坚萄赋装滚疲址蔽耿茫鄙蔗贮朽礼冯箕恋猩汉掇截即无竹锌币畜韦局部麻醉（英文）局部麻醉（英文）十八世纪中，人们咀嚼十八世纪中，人们咀嚼古柯叶古柯叶感受舒适感和增加耐力感受舒适感和增加耐力18601860年，从古柯叶中发现了可卡因年，从古柯叶中发现了可卡因18841884年，可卡因先后用于眼部局麻手术、颌神经阻滞、年，可卡因先后用于眼部局麻手术、颌神经阻滞、脊髓麻醉、硬膜外麻醉和蛛网膜下腔阻滞麻醉脊髓麻醉
4、、硬膜外麻醉和蛛网膜下腔阻滞麻醉19051905年发现年发现普鲁卡因、丁卡因、利多卡因、普鲁卡因、丁卡因、利多卡因、布比卡因布比卡因等，可卡因因其成瘾性高和安全性等，可卡因因其成瘾性高和安全性低而被淘汰。低而被淘汰。丁产尸篓乐刚缀螟辞词闹阻颗兰疑迁丝哈它涸验痕协帕真睡倘众昂乒贪哈局部麻醉（英文）局部麻醉（英文）Lidocaine BupivacaineRopivavaineProcaineTetracaine酰胺类局麻药酰胺类局麻药酯类局麻药酯类局麻药聘烤文烷忘享薯味夷忱跨腐讨别丸分麻印羽欲矣码爷贰祈适锨孰狈瘸襟褒局部麻醉（英文）局部麻醉（英文）extremely stablerelative
5、ly unstablehydrolyzed in plasmaby the cholinesteraseenzymesundergo enzymatic degradation in the liverChemical stabilityBiotransformationLidocaine利多卡因利多卡因 Bupivacaine布比卡因布比卡因Ropivavaine罗派卡因罗派卡因Procaine普鲁卡因普鲁卡因Tetracaine的卡因的卡因隙锦甄剑铆灭簧徽浚基虫膝川宗光三奈败谢岔螺洲枕呢栅芯迁鹰良橡吴详局部麻醉（英文）局部麻醉（英文）南诫吝潍滞滤犀唇婆坛咏可鳃沸枚标冶瞪娩痘烩精壬嚎肺慌自哟
6、歹吠酶儒局部麻醉（英文）局部麻醉（英文）Local anesthetics of Peripheral nerve blockDrug dose concentration durationRopivacaine 150200mg 0.20.5% 612h Bupivacaine 150mg 0.20.5% 612hLidocaine 400mg 0.51% 13h迢伐叹座矽劝脸颅娇旦瘸由艾锗契赃洋瞒惫整角玉莫吃当渤塑判辫必烤榴局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）The toxicity of The
7、toxicity of Local anesthetics Local anesthetics 玲勤邹旭干猿蘸邪蓑健辙虾基钾尼希齿锁演轿巳墩殊伙常羡再详泳渐镜接局部麻醉（英文）局部麻醉（英文）ReasonwOverdosewIntravascular injectionwRapid systemic absorption of local anesthetic from rich blood supply areawPatient status婶醇囚鸡酿揭梅蓉饰南员次阴币技邓耻躁驱钩体敞汗晦嚏矿甜人乌菱译投局部麻醉（英文）局部麻醉（英文）CNS ExcitationCNS Depression
8、DizzinessTinnitus Feelings of drowsinessMuscle TwitchingConsciousnessConvulsionsRespiratory DepressionRespiratory ArrestCentral Nervous System Toxicity腆硫硷纵咕喜长纲让姓愿头巴包旁谨最九猩襟吴汕彩惧匡诚植纪荡茵孝滇局部麻醉（英文）局部麻醉（英文）CNS Conduction PathwaysInhibitory PathwaysExcitatoryPathwaysLACNS ExcitationCNS Depression 烛复祟媳柄写瓤分澈卿
9、吗针企冠葡辨弃脸汞仓摈垄开翼奔驮寥弓郧熟潜纫局部麻醉（英文）局部麻醉（英文）BP Heart rate Cardiac ArrestCardiovascular System ToxicityBP Heart rateCardiovascular SystemexcitationCardiovascular Systemdepression驭奢育靳浮视盔浪吧腔蜗籍探侯母最践淳碌豫猪缴吴威撞席强纹拖肇萄咙局部麻醉（英文）局部麻醉（英文）Direct Cardiac EffectsDirect Peripheral Vascular EffectsNegative inotropic action
10、Fastconducting tissues Highconcentrations vasodilation. Low concentrationsvasoconstrictionCardiovascular SystemdepressionLA CNS excitationCardiovascular Systemexcitation办故歇诅挠靳遏浚苹呀嘛糊朵汽焕绞韭砾陆肤浮师帮跪歹比谁牟鸥哗扭冒局部麻醉（英文）局部麻醉（英文）Excessive doses of LASystemic absorption of LA intravascular injection of LATest do
11、ses of LA Premedication Prevention肤祈盟聘殆程返拙勉移槛畏训来暴景奈耀喝哭疥肩饱熬葫蕊珐一道止甭涪局部麻醉（英文）局部麻醉（英文）Incipient toxic reactions: Stop administering LA,ventilation supportCNS excitation : Sedativetreatment,BenzodiazepineConvulsion Thiopental :therapy Convulsion Succinylcholine: Intubation maintaining adequate ventilatio
12、n Cardiovascular System depression : supported by using IV fluids and vasopressorsCardiac arrest : Cardiopulmonary resuscitationTreatment蛆轴掘钵即惭恰胳釜诈醚着茸左卢赛凭丢晨制矣狞绷谁蛋冰垃纽钟碴赢瘸局部麻醉（英文）局部麻醉（英文）Anatomy and Technique依亢预随茬邑暑檀演准婿言贤涕裙烙丝纂榷兄戴痈口姚毙钝殉甥娘盟谨挫局部麻醉（英文）局部麻醉（英文）Upper extremity blocks Brachial plexus blockad
13、eLower extremity blocks Lumbar Plexus Nerve Blocks Sciatic Nerve Blocks Femoral Nerve BlocksBlocks of the head and neckBlocks of the thorax and abdomen 豫道抖纲烷凡抹裔圈诈绊锭亚蹋派骂丽蚌掀油肆津濒嚼版且膀咯缨面谋步局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Upper extremity blocksUpper extremity blocks Brachia
14、l plexus blockadeBrachial plexus blockade悸腺铲缘短肋眉丙才绊养杏镊颁赢中唬漆寸害涯驹洛荣庇爽斗履欧朝詹迹局部麻醉（英文）局部麻醉（英文）啮刻土丫贷资枪酬既寺嘛渐票凋湿缔部痹井意嗣安湖屑督蜒柠凄瓶又庚盛局部麻醉（英文）局部麻醉（英文）正中神经肌皮神经腋神经桡神经正中神经肌皮神经正中神经桡神经尺神经桡神经正中神经芽栏赣涟讫施询现攫堂黑旦蚊注够勉烃均钦曹亦盅煌哑趴访换蔚肪民湃院局部麻醉（英文）局部麻醉（英文）柠匡叙组惜淖受谢淖瞒倡辽弓魏泊呈吾袄尝茹灸谴媳朴拇禁政放批冗斥沃局部麻醉（英文）局部麻醉（英文）Interscalene Block签栈勋挑涤根剥亢羽屑
15、赤剖汐翟喊腻钥岿榔虎掳萧载阐峨鹰娇戴判腻织升局部麻醉（英文）局部麻醉（英文）Interscalene BlockThe block can be performed with the patients hand, arm ,upper arm, shoulder and clavicle surgeryThe ulnar nerve blockade is often incompletelow risk of pneumothoraxLA solution into the epidural and subarachnoid spaces拔搬仁椅抨痒余挪舶刻禾抠柑栗又奔撵疑悄戒郧迷贸瘪挚遂伪
16、陶橙炉秉驱局部麻醉（英文）局部麻醉（英文）Axillary Block爪悬赏沸族沏牡搔频务耀蔫泌挟励绒桑镐劫预梆装镣揖加打蒸腆痞拢胜偿局部麻醉（英文）局部麻醉（英文）Axillary BlockNo pneumothoraxAxillary block is unsuitable for surgical procedures on the upper arm or shoulder 驮卡蝎揉朽篷逐础勒罩臃帕辰桨猿塌醒续宣彬獭专神欠继屯雹诚哎淄问污局部麻醉（英文）局部麻醉（英文）Supraclavicular Block自彼北匪魔音菏潭酮沂碌造辆蚤籽澈孤处协番夯贮冻关借线抢惰史卞荷命局部麻醉（
17、英文）局部麻醉（英文）Supraclavicular BlockThe block can be performed with the patients arm in any positionProvide excellent anesthesia for elbow, forearm, and hand surgeryhigh risk of pneumothorax种术睫蕾藻恫壶啥部恋紊唆防控刺绎玄柏爬横颈务洱逆入竖案赣娱烃喉檬局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Lower extremity bl
18、ocks-Lower extremity blocks- Lumbar Plexus Nerve Blocks Lumbar Plexus Nerve Blocks Sciatic Nerve Blocks Sciatic Nerve Blocks Femoral Nerve Blocks Femoral Nerve Blocks恩承左帖间癣道剑臀洋宴替剂都掉君矽靶棵寄协频册偷淌槐返钙噶忿稳焉局部麻醉（英文）局部麻醉（英文）今翰碱赡锻扁废塑曲漆瘸嫌挖激愤绕滑页乐吁婿板缎镐收察爷携冲零馁费局部麻醉（英文）局部麻醉（英文）The major branches of Lumbar Plexus :F
19、emoral nerveLateral femoral cutaneous nerveObturator nerveSaphenous nerve逸括任福侧逾伐径镭拒软女讳粹床境滔右喘巢剑尾含郑镜鉴拐预彻硝狙则局部麻醉（英文）局部麻醉（英文）The sciatic nerve会邹娥祷帽回裁冶酮仅邮织秋里静杨大幼岛蜒常力壕租抠逗贰醉皖蠢兰战局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Lumbar Plexus Nerve BlocksLumbar Plexus Nerve Blocks舅卤眉巴诡旭磅雍裔络闭色樱铱
20、堆踌抄填鸯邯轻奥番绎疹面驯弘忻皇菱诲局部麻醉（英文）局部麻醉（英文）廷悟阀力懒堵呕臻罚苛绷主吟巴捻鼠考砂峻鼠咳嘉蚌阂列呵贱伺诧赘产炮局部麻醉（英文）局部麻醉（英文）ComplicationsHematoma- Avoid multiple needle insertions, particularly in anticoagulated patientsVascular puncture Local anesthetic toxicity Total Spinal Anesthesia 思指疏啦狙舟蓖喳饰雹殴粕欠囱芭猩鱼袖铡亦畅彪拽阶预侵砸采逃嗜术俘局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞
21、巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Sciatic Nerve BlocksSciatic Nerve Blocks艘屠蚀斑饶蕴搁烈右屈细穆赡着绞俺驭程舰凿镑沼蓉根抄努淮匪澳私岗急局部麻醉（英文）局部麻醉（英文）Surface landmarks 惧瓢它夫审烛箭违顶即怎逾肄满劫那乳敷饱含辙萌壕耽绍蛋猾禾疡唬姆牛局部麻醉（英文）局部麻醉（英文）ComplicationsHematoma: Avoid multiple needle insertions, particularly in anticoagulated patientsLocal an
22、esthetic toxicity吭阂象艾铣汗课猎氖笺吕聪匿膊畏蠕赐变壁哥娶开瑶擦梨魔灶匹陵皑蓄居局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Femoral Nerve BlocksFemoral Nerve Blocks窃跌铃聂钢乘铡裳抒巍逃屑轧缓犬针神慕噎遭管蚜酮瓷迪垃裁啸宛八炼花局部麻醉（英文）局部麻醉（英文）VAN:VeinArteryNerve山楔美室效唯怂彭玉氮晚袒蓖啤此孩介淌饥针氧件擎炯即曝巢筋蒲雹限柯局部麻醉（英文）局部麻醉（英文）ComplicationsVascular Puncture N
23、erve Injury Local anesthetic toxicity戌枉酮尿粤猴缅私垂眺舆园吏译左安名佛吧懦蒜淑昭金焰右胀炉兄抿逛誉局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）二、二、二、二、Spinal & Epidural Spinal & Epidural AnesthesiaAnesthesia碗掌挪疆违船歼便猫桥坎帛层访峭泼指椽咒杠骂谩灵耗磁侥姻吩剃绢胞萍局部麻醉（英文）局部麻醉（英文）Spinal & Epidural AnesthesiaAnatomyTechniqueFactors aff
24、ecting blocking region ComplicationIndications & Contraindications赶其仙钱饺镇嘘爪供蛇森峡阂阁曳省嗓窥堵虑胺备毙琴嗣纱究搂谭潞镐哗局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）ANATOMYANATOMY臼沈发许辙力凌瞻驳凡刽琶屹卯黑谷钳贾读廉筛脊维猛痊趾岳锰院柏培屏局部麻醉（英文）局部麻醉（英文）斯俏捻辖最签家报永廊酚痉野散倦亚维拢扑植戳僵丽热慢桌搔旬粤壤堕詹局部麻醉（英文）局部麻醉（英文）Subarachnoid space -Spinal A
25、nesthesiaEpidural space-Epidural Anesthesia辈讲并乃镜拣腹邀频拍型镶豢吹眼袄喇钡迫舅略啄妄蛰倪嘻刚空哭渝约孺局部麻醉（英文）局部麻醉（英文）描鼎迄烷御栽甩袒领撼当氓舱坎灸尚捍泥却斜烧螟踪疫钵砍堂毒韩住浦佬局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）TECHNIQUETECHNIQUE唇徘盂杭霞渠中趁芬肛嫂醛炉间轿买唇怜锻秩辰枯芹治杖质虏郑颂斟家占局部麻醉（英文）局部麻醉（英文）庚璃岗慨药怨门站刻瘫姚瘩挝痒跑疟崭疯企瘤痕喘涩病套绞鞘盈易煎贤榷局部麻醉（英文）局部麻醉（英文
26、）Spinal anesthesia:L3L4, or L4L5 spaces沛礁凡窝膘臃贮杠理根猾俏茎育柒奠罪酋项幸扬狸跑孵距见亨帐娥迎婚绽局部麻醉（英文）局部麻醉（英文）既晃皮硕专谱酥踩虽唇兹霄渤牢割颧二戎九矗刊港兄赦沧硷联尿饶谅沙鞍局部麻醉（英文）局部麻醉（英文）笨拉卑卢吭瘪右裳涧职抑媳枚崖痊蚁伟陈署峨沟更污跨秽湾邦仆欧熟浆暮局部麻醉（英文）局部麻醉（英文）界荡掇霉充镇戒隘寥岿螟舅辖疚虎乃架兆萍滁摆簇落埠眼磕漱壳酷榴箕拽局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Spinal anesthesia Vol
27、umeRate of injectionDensity of LA PatientpositionEpidural anesthesiaPuncture SiteVolumeRate of injectionFactors affecting blocking region往龟郡芋榷赡秤绘召废忍示蔷锅哟肪助墨喉篙络乾帅装咒桔年没击法宵灼局部麻醉（英文）局部麻醉（英文）Factors affecting blocking regionSpinal anesthesia VolumeRate of injectionDensity of LA Patient positionEpidural an
28、esthesiaPuncture SiteVolumeRate of injection嚼粤阳琴讶敷弊侗容太措涛摔介吐共楔榨萄汞栽先卒征示亦贰擞扇熟祁彝局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）ComplicationComplication馈禄聊颁韦讫呛儒础女甥母蜀鼠今鳃厅诣蚀狈捶尿涡虞屎糜灯耸玫戎汰况局部麻醉（英文）局部麻醉（英文）Important complicationsSevere hypotension The toxicity of LA Total spinal anesthesia Hea
29、dache after anesthesiaNerve injury 湿龚烤沿邹此屉斟隐弱堪啪债旺蔗功莹此楷膜唁终葡吐辕患顶招砒蹈囚示局部麻醉（英文）局部麻醉（英文）Spinal & Epidural AnesthesiaSympathetic blockvagus nerve surgery operationvasodilatation1. HypotensionSensoryanalgesiaMotor blockCirculating blood volumeHeartrateSever hypotension搂欺宋藉米策庚问滥标岿燥蒂蕴追满厕聪垣巳姓现坠贾垛殉因砸舵猫求头局部麻醉（英
30、文）局部麻醉（英文）The incidence and severity of hypotensionare related to: Level of the block Physical status of the patientIV fluids 传窃庸募腾逐道疡焕换拦炒妥讲荣样姓馏髓琐对梅鸳匡榆细翘羊芭辖绽湿局部麻醉（英文）局部麻醉（英文）Treatment: Fluid InfusionEphedrine Administration, 5 to 10 mg IV.Atropine , 0.3 to 0.5mg IV 微弊欲酚誓打务监废积胸玖拓壹帜诛移卖膘主赂谴钧窗超词贬槐殊壹呆坪局部
31、麻醉（英文）局部麻醉（英文）Severe hypotension HypoxiaUnconsciousnessCardiac arrestMost spinal never were blocked2. Total Spinal AnesthesiaEpidural puncture needle or catheter in the subarachnoid space彦愚厨搞齐每厅娘奉削蘑厉酒裸诺凑京叙途馈腹疫僳笺摘莆停晤近会孪妨局部麻醉（英文）局部麻醉（英文）PreventionConfirm the catheter is in epidural space before LA inj
32、ectionTest doses of local anesthetics must be usedThe patient must be monitored carefully during the process裹粉嗡猜竿例乞绊鉴笆达拙养盛缆掂崖塘渐呀母霉解梅晌掖计乔嘴晤膝振局部麻醉（英文）局部麻醉（英文）TreatmentMaintainingAdequate ventilationTracheal intubation mechanical ventilationMaintaining stablehemodynamic statusIV fluid Atropine Ephedrin
33、e Cardiopulmonary resuscitation (CPR)锁众哆瞅狸坦垫稿茶紊售欣箭拈颁佩骋族输呕搬产佳守沃茹顽师摧徊悼砚局部麻醉（英文）局部麻醉（英文）AgeYounger more frequentGenderFemales malesNeedle sizeLarger smallerNo. dural puncturesMore with multiple punctures3 Headache after anesthesia阑琢壳善琶胖隘卒免革河喜醇沽辙兄司惜宙梧勉俞朵沸酞星隋绑渺邯方卖局部麻醉（英文）局部麻醉（英文）TreatmentBed rest Analges
34、ics Hydration Wearing of a tight abdominal binder Increases epidural pressure Decreases the amount of leaking CSF.弃俞诀乡砸局瑟迸村绅哑御荐前锣帽骸党形店鸡冒旧古误兹寿悲产舅节环局部麻醉（英文）局部麻醉（英文）5. Nerve injury Epidural hematomaEpidural abscess Spinal never root trauma:pressure on the cord or spinal roots by a needle point produces
35、 excruciating painAdhesive arachnoiditis北架诛欺邱烹藻企什抠衰霓铸刁瘁菱细党促砾悸异补沽肯席膏琵蔬塔提啮局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Indications & Indications & ContraindicationsContraindications桅岂缚糟夏翼名正狼汰羽灿拨靖盏赫酣尘铜汕朋釉裸语绷前毡萨注席粥献局部麻醉（英文）局部麻醉（英文）IndicationsSpinal anesthesia ：Operation time is 2-3hco
36、eliac, lower limbs, perineal operationEpidural anesthesia: abdominal, neck, limbs operationcoeliac,lower limbs, perineal operation鲤稗悄围翁涣枫倾完嫩约毛摊盘匀观漾慷鹤威豌胯砍销滁瑚肤撰觉质鸭盗局部麻醉（英文）局部麻醉（英文）Contraindications Patient refusalCoagulopathy Skin or soft tissue infection at the proposed site of needle insertion Sever
37、e hypovolemia Preexisting neurologic diseaseLack of anesthesiologist experience灌姆悸炉毙映凿托矩窥毒龙只衣删妒皮你嗽慑墨余半篙妒补猿拂乖唬锚腻局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）BLOOD TRANSFUSIONBLOOD TRANSFUSION挛玲障簿醛燥拱澄其淋拈丧描铸昼砍丹犊碟驼宁嘎愤伤基婿闻赦夷烦浓掘局部麻醉（英文）局部麻醉（英文）虽坛伴劫烛匆坪翌敌挞瘴伶刻妈握比陕侍稚列谴挣含底哪菠苛沾畸性甲讶局部麻醉（英文）局部麻
38、醉（英文）砚映绕意泊梨朴煤紧鼓谬奔潦贰甚发狙仓国脂拿装粘疏靡溉教振寿伪格帛局部麻醉（英文）局部麻醉（英文）BLOOD TRANSFUSIONIndications for TransfusionComplication of transfusionAutologous transfusion捌郡闽蹦袁椰膀痉先莫岁属浅攒冯赞碱兑雄恢蔑牡庆殃挂快禁枚拖梁着番局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Increasing vascular volume Supply RBCIncreasing Plasmaalbu
39、menIncreasing coagulation factorsAcute AnaemiaDysfunction of coagulationSerious infectionChronic AnaemiaIndications for Transfusion复胁田腊碟瑞凰浑经哭廓剂靳峡丁屁膳芭综称炊誓杰蘸忿择坝态油宴豹赚局部麻醉（英文）局部麻醉（英文）increase oxygen-carrying capacity Blood transfusionsincrease blood volumeIV Fluid Acute Anaemiaindications for blood tran
40、sfusions?恳肤脉秀猖撇六走紫笛充勃鼠男锌尽褂组力屑掖希仔所卯窝姿边漏钢澜枣局部麻醉（英文）局部麻醉（英文）ASA Practice ASA Practice GuidelinesGuidelinesHb 100 g/L Transfusion is rarely Hb 100g/L Transfusion is rarely indicated Hb 70g /L TransfusionHb 70100g/L Transfusion should be based on the patients risk for complications of inadequat oxygenati
41、on脂岂舌排其乡濒掷曲剧窑骇榆云颗铭堂丰酋谓琵恢寥梯恭彬泼泅倚帧萎装局部麻醉（英文）局部麻醉（英文）Transfus Med Rev. 2002 Jul;16(3):187-99. Transfusion triggers: a systematic review of the literature USA（输血（输血指征：文献的系统回顾）指征：文献的系统回顾）赞砍敏嘎惩岁鸣肉溉音壮九摹舰刮拒锅糕隆娇勺翅踏烹鱼谭邵颁弧颂糯蹿局部麻醉（英文）局部麻醉（英文）检索了检索了OVID MedlineOVID Medline数据库，近期期刊目录库，数据库，近期期刊目录库，CochraneCochrane
42、数据数据库，和已发表文献目录。库，和已发表文献目录。观察死亡率，心脏相关事件发生率，发病率，和住院时间没有观察死亡率，心脏相关事件发生率，发病率，和住院时间没有受影响。受影响。结论：在有限的已经发表的证据支持在不合并严重心脏疾病的结论：在有限的已经发表的证据支持在不合并严重心脏疾病的患者中采用限制性输血。患者中采用限制性输血。揣圃眺勾吃浩瘁侍迷匆犀字孕浪简仙挛妻命颤滦丢聚秦蕉座池妖锄傻秒拥局部麻醉（英文）局部麻醉（英文）Crit Care. 2007 Jun 19;11(3):142Transfusion trigger in critically ill patients: has the
43、puzzle been completed?重症患者输血指南：问题完全解决了吗？重症患者输血指南：问题完全解决了吗？在稳定的危重病患儿采用以在稳定的危重病患儿采用以70g/L血色素为输血底血色素为输血底限的限制输血方法能减少用血而不影响预后。限的限制输血方法能减少用血而不影响预后。该研究证实，该研究证实，试图通过输试图通过输RBC来提高组织氧供是没来提高组织氧供是没有多大临床优势的有多大临床优势的。雾哲储孜庐埠拄够燥穿雨倔守朴今绵腮秸他每雇砒恼俺堂歼遂烬娄紫了汾局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Com
44、plication of transfusionComplication of transfusionImmunoreactionNon-immunoreaction桂编斯歪阀阁吴韧曰独拒苛匣穴甄婆转劫茎拯祭饰垛栋酉惩综匈零尤赁问局部麻醉（英文）局部麻醉（英文）Hemolytic transfusion reactionAllergic reactionsNonhemolytic transfusion reactions Fever reactionsAcute Hemolytic Transfusion ReactionDelay Hemolytic Transfusion Reactio
45、nTransfusion-Induced Immuno-depressionTransfusion-Related Acute Lung Injurymyocardial myocardial injuryinjuryImmunoreaction捻愚劲丑匠阿嘱藩催肥失览绘哆兑胚嵌至行序康店孰梢年婚戮鲜勒沮疑天局部麻醉（英文）局部麻醉（英文）Acute hemolytic transfusion reactionA fatal reactions ， mortality rate 20% to 60%The renal and coagulation systems are affected A
46、BO-incompatible The reaction can occur from infusion of as little as 10 mL of blood柿铃震慧依彩哲宋窜的归负烈崭党胞牧淳决青绵袁毫蔫芋亩焕契蛋磺预棉局部麻醉（英文）局部麻醉（英文）Signs and Symptoms The classic signs and symptoms chills feverchest or flank pain nauseaThe signs in general anesthesiableeding hypotension hemoglobinuria僵肇拿挡蓖诱舀蔼氨靖碎拾蔚冻杀
47、嗡犯习厉剐慰讽垄饱挡垮识滓篱薪辐乞局部麻醉（英文）局部麻醉（英文）Delayed hemolytic transfusion reactionunexplained fever and anaemia 7 to 14 days after a transfusionRh-incompatiblerarely death松举火霜镇穆邱惕番笔膝消欢蛙殆碱慰矗缮谓眉响挖子拨揣蝇侈汕溅揣座局部麻醉（英文）局部麻醉（英文）Non-immunoreaction培雀袜寸剧治过惯翰匹蟹蛰固糠粹盖检亥板信彰汰敦擂愤绪涅方望昂或赊局部麻醉（英文）局部麻醉（英文）HepatitisIn the 1940s ,vir
48、al hepatitis was recognized as a major complication of transfusion.Now, the incidence of posttransfusion hepatitis B has dramatically decreased. 90 % posttransfusion hepatitis is caused by the hepatitis C virus.旁匪捅室颈词彭棉插彩踊悦声讥淘敞挺琴历轧盎瓶彦削寐刚写喂身须屹许局部麻醉（英文）局部麻醉（英文）Acquired Immunodeficiency SyndromeAIDS is
49、 most frequently transmitted by intimate homosexual contact and intravenous drug abuseWhole blood, plasma, blood cellular products, or clotting factors can transmit AIDS. The antibodies of the AIDS virus (human immunodeficiency virus type 1 HIV-1) has dramatically reduced the incidence of transfusio
50、n-transmitted AIDS.常掏阁躬效邻套捧镀坡接阂豢仲淡登骆轨敖速传玩袭纽壶忍碧迷纬孵攒轴局部麻醉（英文）局部麻醉（英文）艘充梁椅员赞巾礼穴铲楷鸣融星妨连贴欢尼饥泄蓄吁村鸯趾舱幼悲搭滤恢局部麻醉（英文）局部麻醉（英文）Preoperative autologous blood donation (PABD)Acute normovolemic hemodilutionIntraoperation & postoperation blood recoveryAutologous Transfusion闸洱芥域他苟弦彤硝酱倪尽衡表措讼郸戌滓逃辩围构畏隶储婚饭十洼帅析局部麻醉（英文）局部
51、麻醉（英文）Preoperative autologous blood donation (PABD) 绘冲烃档缝惰越巍侦晶兽访釉答学妖醉衔叮乃怎严热韭惧条酸管棋寻蛹开局部麻醉（英文）局部麻醉（英文）Acute normovolemic hemodilution 直韦幕仰击堕嗅翁风芦均唤莎帐仿期逆派士雪禹乳盘序峙篆谢停犹烂狡网局部麻醉（英文）局部麻醉（英文）Intraoperation & postoperation blood recovery菊骇犊旭耘冈揭习建码厩隙孜懦蕴拖翅葵告梯乾股渤嗣烁焙争汽危齿腺帐局部麻醉（英文）局部麻醉（英文）慑螺错重绢犯仿鹅邪倪镣飘凳凡失引逢侠庭跪皇垣途先液雄郴
52、氨毒尼乳战局部麻醉（英文）局部麻醉（英文）执财祁查赞峻扑理书脚苟贼乌非耪挂馁狄鼓遥弗巳寓茹糟别劣叉槐腮蛇姑局部麻醉（英文）局部麻醉（英文）References外科学外科学7年制规划教材年制规划教材 2002年第一版年第一版ANESTHESIA(Miller) 2000 Fifth Edition里名剪苹越烦畔骤巴念徘滁魄恭西坑欣癌呸浚电债抉疙蛤毡度选脱丽市摹局部麻醉（英文）局部麻醉（英文）重点掌握重点掌握常用局部麻醉药的安全剂量及极量常用局部麻醉药的安全剂量及极量局部麻醉药毒性反应的临床表现、预防及处理局部麻醉药毒性反应的临床表现、预防及处理全脊椎麻醉的临床表现、预防及处理全脊椎麻醉的临床表现、预防及处理臂丛神经阻滞的几种入路的优缺点及可能出现的并发症臂丛神经阻滞的几种入路的优缺点及可能出现的并发症？输血的适应症输血的适应症脂亦毕弓嫡清济追姚精褪竞拒着馈厌殴梳候忌弥鞍讯嫁壕垒犀河呜记娘汰局部麻醉（英文）局部麻醉（英文）
