俞卫锋定量吸入麻醉的理论与实践课件

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1、定量吸入麻醉的理论与实践东方肝胆外科医院麻醉科俞卫锋1MethodsofAnaesthesiaClassicAnaesthesia:tooffer(asurplus)ofanaestheticgasestofulfiltherequirementsofanaesthesiaQuantitativeAnaesthesia:tooffertheexactamountofanaestheticgasesrequiredbythepatienttofulfilanaesthesia2BASEOFTHEC

2、LASSICALSYSTEMStoofferagasmixtureofdefinedO2%withcarrierandavolatileaddedtoit.toeliminateadequatelytheover-supplyofgases(pop-off)3FGFCO2-ABSORBERBellowsPOP-OFFExspirationlimbInspirationlimbValvesClassicalrebreathingsystem4Whatdowedotodaywithinhalation

3、alanaesthesiauptakePop-off5BasisofQuantitativeAnaesthesiatoofferO2ofaset%accordingpatient’suptakeanaesthesiagasesaccordingMACtoremoveadequatetheCO2productionofthepatient6QuantitativeAnaesthesiabyrealclosedCircuitO2freshgasflow=patientuptakeN2Ofreshgas

4、flow=patientuptakeVAadministration=patientuptakeCO2elimination=patientproductionFGFCO2ABSORBERMEMBRANEBLOWERAGENT7whataboutQUANTITATIVEInhalationalANAESTHESIAuptake8定量麻醉的理论基础9再吸入技术简史1850年JohnSnow观察到呼出气中麻醉性气体未发生变化Coleman、Jackson、Waters、Gauss、Sudeck、Sc

5、hmidt、Drager和Sword采用吸收CO2方法首先使用了再吸入系统1924年，RalphWaters提出这种麻醉方法的优点包括减少热量和湿气的丧失，节约麻醉药用量以及减少手术室污染三氯乙烯与碱石灰不相容，导致定量麻醉几乎被废弃现代精密麻醉机及新的稳定麻醉剂的发明为定量麻醉技术注入新的生命10towardsQAto-and-frosystembyRalphWaters1924Improvedconditionsforthepatientdueto:noheatandmoisturelos

6、sminimaluseofanaestheticagents,whichresultsinamuchquickerandmorepleasantrecoveryCostreductionofanaestheticagentsusedProtectionoftheOR-teamagainstthecumulativeeffectsofanaestheticdrugsInvestigationopportunitiesintothecomparativeeffectsofdifferentdrugso

7、ntherateofmetabolismduringanaesthesiaConsumptionofoxygeniseasilychartedinmililitersperminute11introductionofQALowandErnst:Quantitativepracticeofanesthesia1978squarerootoftimemodel12吸入麻醉方法的分类根据有无重复吸入以及重复吸入的程度将吸入麻醉的方法分为以下三类：1．无重复吸入系统（Non-rebreathingSys

8、tem）2．部分重复吸入系统（PartialRebreathingSystem）3.完全重复吸入系统（AllRebreathingSystem）13无重复吸入系统Non-rebreathingSystems指系统中所有呼出气体均被排出，这就是传统上所称的开放麻醉，现在几乎不采用吸入系统与呼气系统隔离新鲜气流量大于分钟通气量新鲜气中各气体浓度等于吸入气中浓度14PartialRebreathingSystem系统中部分呼出混合气仍保留在系统中.CO2吸收剂将呼出气中的二氧化碳滤除新鲜