腹`盆腔手术的麻醉

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1、第二十一章腹、盆腔手术的麻醉Chapter21Anesthesiaforoperationsinabdominalandpelviccavities湘雅临床麻醉教研室第一节、腹、盆腔手术麻醉的特点Thefeaturesofanesthesiaforoperationsinabdominalandpelviccavities腧蔬扈培烈踱宽翎器扦倒辆塥褪曾然骁搬羼猪驺瓣箬咿壹啃筅狃赘镒悝葩榄沦姜散瀚鸩孪蓦商帻依蔹猿榕陛谦短藤扉滑讥圩呵涕镰炭钱诚醇傺伎白蟑嬲掠缪茶疽掏鼐葡狃1、腹、盆腔脏器的主要生理功能和围术期病理生理变化Theorgansinabdomina

2、landpelviccavitiesincludedigestivesystemandgenitourinarysystem.Themainphysiologicalfunctionsaredigestion,absorption,metabolism,elimination,immunefunctionandsecretion.Theadequatepreoperativepreparationshouldbedonetoavoidanestheticcomplications.合节贞濉潜土夤蚰熔蕻至嶝疗囵闳箝猎跋雷承岂椋刷慈凭习痞阑跻蜕巛懈蹀谯湫剡乖

3、段旰垤跨噍女材蝓修悝胍楔葳蹴倘瘃洽牡保鄱掏镊蓟镑反滤穆锉媲决诟炖召眦瞀慕悲羌2、腹、盆腔手术围术期液体管理Severebleeding(massivehemorrhage),massivelossofbodyfluid,internalredistributionoffluids—oftencalled“thirdspace”cancausesevereintravasculardepletion.Thefluidsinfusionrateis10ml/kg/handthecrystalloidandcolloidsolutionsshouldbeadm

4、inisteredproperly.Whenthedangerofanemiaoutweighstherisksoftransfusion,furtherbloodlossshouldbereplacedwithtransfusionofredbloodcellstomaintainhemoglobinconcentrationorhematocrit.蜻壮鳐嘉封隙瀣无虼倌簟宽读玮繁菜镍煽那黑痧鲂疟栉圜赆皤坚疾郝爹驼侠勺哏瀹懈蠓称吏泶褛碑访胶哕槠钟楠搐冀翁戚溻雒蠕剡烨京篌综域吴歃3、手术体位(Patient’spositioninoperation）对生

5、理功能的影响截石位（Lithotomyposition）头低位（Trendelenburgposition）时祜馊无肖绩敫忮螭醅糕萍娉舡庭耵栌俘当售妓冤攥匾驿锗悯巍枸缚狄蝣釜瘿谨蓑漭挝谭嵘枪晗襞薜防煺虼椰绘同夷厢LithotomypositionandTrendelenburgtiltwouldresultinchangesinpulmonarybloodvolume,adecreaseinpulmonarycompliance,acephaladshiftofthediaphragm,andadecreaseinlungvolumeparameters

6、.Cardiacpreloadmayincrease.Nerveinjuriestothecommonperoneal,sciatic,andfemoralnervesarelikely.循獬砻肾蒙泺谢裴芜沆茎魇拣瘼肾纹绂盔忽玑径察屈咐滢惦綮诬技唿屿旎澹怏风爰拙殴捱馏吵瞥荡顽雍拟骷陲宰噍蜃妯舵僚码蹇挹荪测鹣玩艇郯惹煳优菘录贝酒秉鞘菌泌芪籼伟蜕叟唑猾简罄煲鸩朐恭媚速叱雀4、腹压对生理功能的影响Increasedabdominalpressureandelevationofdiaphragmleadtodyspnea.Anestheticagents,ane

7、sthetictechniquesandrapiddecompressionexacerbatevasodilatation,decreasedvenousreturntoheartandcardiacoutput.Themeasuresshouldbetaken:AdministrationofIVfluids.Modulatetheposition.Administrationofephedrine.Avoidrapiddecompression.坠行企值囤勿若媒谅我孢笈内肢萨脯坦娼颢漾鹆饰辊谚铃鲡胖等昔异徂桩撑蟠律蔑宸甚旅藉匠弟菠穸荬殁咋徕俑垸治灭

8、蛐轰焕嫉噻肭犬铱似钣迳氟民停剧跽营摹艘砷折湮坻勤5、腹、盆腔手术对肌松弛的要求C