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产科麻醉及相关问题PPT课件

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This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 产科麻醉及相关问题产科麻醉及相关问题 吉林大学第二医院麻醉科吉林大学第二医院麻醉科 Anesthesiology . 潘振祥 Date1 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 产科麻醉及相关问题产科麻醉及相关问题 吉林大学第二医院麻醉科吉林大学第二医院麻醉科 Date2 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v产科麻醉关系到产妇与胎儿二者 的安危。美国一项调查研究报道 80%的麻醉死亡率发生于产科急 诊,而其中52%发生在全麻。产 科麻醉需考虑到该麻醉方法是否 影响子宫收缩、子宫胎盘循环对 胎儿是否有不良影响等问题。 Anesthesiology . Date3 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 麻醉死亡风险 Date4 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v术前管理 v产科麻醉用药及其特点 v产科麻醉方法的选择 v产科麻醉合并症及其处理 v妊娠期的非产科麻醉 2 3 4 5 1 Date5 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 术前管理 v术前检查 v禁食情况:剖腹产多为急诊、饱胃患者 ,择期手术至少禁食6小时,防止返流误 吸,将给母婴造成致命后果。 v了解既往病史:药物过敏史及有无高血 压、糖尿病等妊娠合并症。 v常规检查项目必须进行凝血功能检查。 Anesthesiology . Date6 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v术前用药 ™不建议常规术前用药(如阿托品,心率的增加 可增加产妇的耗氧)。 ™妊高症者降压药持续至术前。 v术前准备 v麻醉机和复苏用品,包括新生儿复苏用品 及抢救药品。胎儿娩出时应有新生儿医生 协助治疗。 Anesthesiology . Date7 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. Date8 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 产科麻醉用药特点 ™药物通过胎盘为被动扩散。即扩散系数越高的药物越 容易通过胎盘。促进药物扩散的因素有:低分子量、 高脂溶性、低离解度、低蛋白结合率。 ™多数镇静、镇痛药和麻醉药都是低分子量、高脂溶性 、低离解度、低蛋白结合率,因此可早期通过胎盘。 ™肌松药多呈水溶性、离子化、高分子量,因此不易通 过胎盘,但并非不能通过。 ™局麻药极性强,受蛋白结合率的影响,胎儿酸中毒可 促使胎儿血中局麻药浓度升高。 ™高血压、糖尿病、妊高症可损伤胎盘毛细血管屏障, 从而导致药物非选择性通过胎盘。 一、药物的胎盘通透性 Anesthesiology . Date9 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 二、麻醉用药 Anesthesiology . 静脉麻醉药 肌松药 局麻药 吸入麻醉药 Date10 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 吸入麻醉药 胎盘屏障对子宫收缩的影响吸入浓度 氧化 亚氮 可迅速透过几乎不影响子宫收缩,甚至对子 宫收缩力有增强作用。 3l/min浓度最 高不超过70% 恩氟烷可通过低浓度吸入时对 子宫收缩的抑制 较轻 1.5MAC 异氟烷可通过呈剂量相关性,浅麻醉时抑制宫 缩不明显,深麻醉时对 子宫较 强 抑制,易引起分娩出血。 1.5MAC 七氟烷更易透过对子宫肌的抑制作用强于异氟烷不易于用于产 科麻醉 Date11 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 静脉麻醉药 v 目前所应用的静脉麻醉药基本上均能透 过胎盘屏障,重点介绍以下几种: ™异丙酚 ™氯胺酮 ™咪唑安定 ™γ-羟丁酸 ™硫喷妥钠 ™阿片类镇痛药 Date12 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v(1)氯胺酮:1968年用于产科,具有催产、消除 阵痛、增强子宫肌张力和收缩力的作用,对新生 儿无抑制,偶可引起新生儿肌张力增强和激动不安 (有的报道占2%)。氯胺酮静脉注射1.5mg/kg, 可作为全麻诱导,或在胎头娩出时静脉注射 0.25mg/kg,用量超过2mg/kg时可引起子宫收缩并 对新生儿有抑制作用。氯胺酮禁用于有精神病史、 妊娠高血压综合征或先兆子宫破裂的孕妇。 Date13 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v(2)异丙酚脂溶性强,可以迅速通过胎盘,有可 能引起新生儿呼吸抑制,但这种情况出现于大剂量 (用量超过2.5mg/kg)使用时。目前有临床证实, 由于丙泊酚代谢迅速,血药浓度下降很快,所以 不会引起新生儿长时间呼吸抑制。有研究表明当应 用2mg/kg丙泊酚进行麻醉诱导时,发现新生儿无 呼吸抑制发生,但该药说明书强调:妊娠期异丙酚 除用做终止妊娠外,不宜用于产科麻醉。该药在产 科病人中应用还没有得到FDA 认可。也有人报道 :异丙酚无论用于全麻诱导或维持,很多产妇发生 低血压,故应慎重。哺乳期母亲用后对新生儿安全 尚有顾虑。 Anesthesiology . Date14 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v(3)咪达唑仑 高度亲脂性,微溶于水,在体内 释出亲脂性碱基,可迅速透过胎盘,但透过量 小于地西泮,对胎儿的影响尚不清楚。具有抗 焦虑、催眠及抗惊厥的效力。本身无镇痛作用 ,但可降低吸入全麻药的MAC,与麻醉性镇痛 药有协同作用,有一定的呼吸抑制,对血流动 力学也有影响。可用于麻醉诱导。 v(4) γ-羟丁酸钠 具有增加宫缩 频率和速率, 强化催产药作用和促进宫缩的作用。可透过胎 盘预防胎儿缺氧性脑并发症。一次静注60mg/kg 快速诱导,本药禁用于严重的妊娠高血压综合 征、先兆子痫或低钾血症产妇。 Anesthesiology . Date15 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v(5)硫贲妥钠 不影响子宫收缩,可迅速通过胎盘,但 胎儿的摄取量与母体所用剂量不呈正比关系。大剂量 硫喷妥钠可抑制新生儿呼吸,故应限制剂量不超过 7mg/kg。本药可考虑用于麻醉诱导。 vγ-羟丁酸钠及硫贲妥钠目前已很少用于临床麻醉。 v(6)麻醉性镇痛药:对子宫收缩及子宫胎盘血流量 无影响,但对新生儿有明显的呼吸抑制作用。产科麻 醉中,阿片类药物一般都是在胎儿娩出后才给予。 Anesthesiology . Date16 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 肌肉松弛药 v不影响子宫肌肉的收缩与松弛,对子宫血流量的 影响是通过影响血压造成的,对子宫血管无直接 作用。 v去极化肌松药 v 琥珀胆碱胎盘通过性较小、且很快被血浆胆 碱脂酶分解,其脂溶性低,且可被胆碱酯酶迅速 分解,故在常用剂量时,极少向胎儿移行,新生 儿体内亦无此药。但用量在300mg以上或一次大 量使用,仍会移行至胎儿。静脉注射1.5mg/kg, 可作为全麻诱导。如果孕妇胆碱脂酶活性异常, 使用琥珀胆碱后,偶可引起母子呼吸抑制。 Anesthesiology . Date17 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v非去极化肌松药 v 近年来,新的非去极化肌松药逐年增加 ,其中以阿曲库铵和维库溴铵或可作为标准 药。哌库溴铵和杜什氯铵为较新的肌松药, 此后开发的以短效见长的美维松和中效的罗 库溴铵,使临床用药有更多的选择。上述药 物都是高度水溶性药,故不易(并非完全不 能)通过胎盘屏障。 Anesthesiology . Date18 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v产科使用的理想肌松药应具备: ™起效快; ™作用持续时间短; ™很少通过胎盘屏障; ™新生儿排除该药迅速等。 Date19 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v阿曲库铵的理想化特点接近上述条件,脂溶 性低,50%与蛋白结合,所以通透胎盘屏障 受限。有临床观察,给剖宫产的产妇使用阿 曲库铵0.3mg.kg ,肌松满意,作用持续时间 短,仅微量通过胎盘,胎-母间比值为12% ,娩出新生儿Apgar评分正常,但生后15分 钟时仍有残存肌松现象,这对不足月的早产 儿应予以注意。 Date20 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 局麻药 v(1)有子宫血管收缩作用,子宫血流量下降程度与 其血中浓度有关。文献报道,导致子宫血流量下降 60%时局麻药血中浓度如下: v利多卡因 200ug/ml, v普鲁卡因 40ug/ml, v布比卡因 5ug/ml。 v故若从硬膜外阻滞所用之浓度来看,利多卡因的安全 性是相当高的。 v(2)酯类与酰胺类局麻药均可通过子宫胎盘屏障, 但由于前者可被胆碱酯酶分解,对胎儿影响小。后者 与蛋白结合率高,胎盘通透性低。 Anesthesiology . Date21 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 产科麻醉 v(一)术中管理 v(二)输液 v(三)合并症的处理 产科麻醉虽然在技术上并不复杂,但其风险较高。麻醉 医师必须熟悉妊娠期间孕妇生理的改变及各种药物对胎儿的 影响,确保孕妇和婴儿的安全。麻醉方法应根据产妇的全身 状态、是否紧急、术前准备情况、术者及麻醉医生的熟练程 度而定。 Anesthesiology . Date22 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 术中管理 v监测 除常规监测外,应有胎心监测 v体位 标准体位为仰卧,右侧抬高15-30度,并将 子宫向左侧推移。 Anesthesiology . Date23 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 麻醉方法的选择 v硬膜外阻滞 v腰麻-硬膜外联合阻滞 v全身麻醉 Anesthesiology . Date24 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 硬膜外阻滞 v硬膜外阻滞是剖宫产术的首选麻醉方法。 Anesthesiology . 主要 指征 特点 作用持续时间不受限制; 可长时间保留硬膜外导管,有利于术后镇痛; 血流动力学变化比较缓慢,有一定的代偿余地; 肌松作用相对较弱,仰卧位低血压综合征发生率 较低。 Date25 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v操作方法:穿刺点腰2、3或腰1、2,向头端 置管3cm;局麻药用量较非孕妇减少1/3,试 验量(1.5%-2%利多卡因,3ml)。常用局麻 药为1.5%-2%利多卡因、0.75%罗哌卡因不 加肾上腺素,麻醉平面达到T5左右。 0.75%布比卡因可引起心跳停止,故应 慎用于硬膜外产科麻醉。 注 意 Date26 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 腰麻-硬膜外联合阻滞 v近年来,腰麻-硬膜外联合阻滞(CSE)在产 科的应用越来越多。它结合了腰麻和硬膜外 的特点,起效快,肌肉松弛良好,用药少, 对胎儿影响小,并可任意延长麻醉时间,术 后可行镇痛。由于穿刺针技术的改良,对硬 脊膜的损伤小,减少了脑脊液的外露,使术 后头痛的并发症显著降低。 Anesthesiology . Date27 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v操作方法:选择L2、3或L3、4间隙穿刺点, 在硬膜外腔穿刺成功后,将蛛网膜下腔穿刺 针套入硬膜外腔穿刺针穿刺,见脑脊液回流 ,缓慢注入0.5%的布比卡因8-10mg,可加少 量芬太尼(10ug),以减轻术中不适感。药 液注入完毕,拔除蛛网膜下腔穿刺针,再从 硬膜外置管。 Anesthesiology . Date28 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. vCSE对孕妇的循环系统影响较大,可出现急剧 的血流动力学改变,容易出现仰卧位低血压综 合征。 v 近来,通过放射学检查发现,在平卧位时 约有90%临产妇的下腔静脉被子宫所压,甚至 完全阻塞,下肢静脉血将通过椎管内和椎旁静 脉丛及奇静脉等回流至上腔静脉。引起椎管内 静脉丛怒张,硬膜外间隙变窄和蛛网膜下腔压 力增加。因此, 局麻药的用量较非孕妇减少 1/3-1/2。 Anesthesiology . Date29 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 全身麻醉 适应症: 1、凝血功能障碍(如血小板减少、血友病、再生障 碍性贫血、阵发性睡眠血红蛋白尿等); 2、局部或全身感染; 3、低血压休克; 4、严重心脏合并症(子痫、心脏瓣膜病变、艾森曼 格综合征、主动脉狭窄) ; 5、严重神经系统疾病(颅脑肿瘤、颅脑外伤); 6、急性严重的胎儿宫内窘迫(如脐带脱垂)等; 7、区域阻滞失败。 Anesthesiology . Date30 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v特点: v1、快速诱导可使手术立即开始,为抢救婴儿 生命赢得宝贵时间; v2、可保证患者气道通畅和肺通气; v3、血流动力学干扰小,可减少低血容量患者 低血压的发生率,维持母婴血流动力学稳定 。 Anesthesiology . Date31 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 操作方法 诱导前服用抗酸药 给氧去氮 皮肤消毒、铺单 麻醉诱导 氯胺酮 异丙酚 (1-1.5mg/kg) (1-2mg/kg) 入睡后静注琥珀胆碱(1.5mg/kg) 压迫环状软骨,行气管插管 胎儿娩出前,可给予吸入麻醉维 持(常用50%笑气和氧气,必要 时可吸入0.75-1.0%的异氟醚) 胎儿娩出后,停止吸入麻醉药, 给予静脉麻醉药及阿片类镇痛药 术毕,患者清醒,拔除气管导管 Date32 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. 全麻注意事项 v①择期手术应禁食6-8小时。 v②仔细选择全麻药物及剂量。 v③有效防治仰卧综合症。 v④断脐前避免过度通气, 以防止子宫动脉收缩后继 发胎盘血流降低, 对胎儿造成不利影响。 v⑤认真选择全麻诱导时机待消毒, 铺巾等开刀准备 就绪后再诱导, 以尽力缩短切皮、打开子宫至胎儿 娩出间的时间间隔。 Anesthesiology . Date33 This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 m sensor. v此外,应切实注重气道管理。 v 由于足月妊娠后产妇毛细血管充血,体内水分 储留, 致舌、口底及咽喉等部位水肿。另一方面
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