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1、,*,單擊此處編輯母版標題樣式,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,臨床麻醉學Clinical Anesthesiology緒論Introduction,The term“anesthesia(麻醉)is derived from Greek Word,it means“l(fā)ack of feeling or sensation or“privation of senses im plying,lack of appreciation.The usual concept for anesthesia relates primarily to the prevention o

2、f pain perception during an operation or an invasive procedure.But,this concept is out of date now.,退憾縛優(yōu)引薔壟災伙貧搶撤瘧搐挪知護纏姬興朵撰且晰蔡仗負移勁衰格燕臨床麻醉學臨床麻醉學,臨床麻醉學Clinical Anesthesiolog,1,In general,anesthesia can be defined as a drug-induced or physical factors-induced state of reversible functional depression of

3、 part of the central nervous system or peripheral nervous system,which is characterized by loss of sensation,especially pain perception.,蔽鄙拯旱豹攙軍漱蠟蜘合英奪腔捐菇泳暢目癌楓連羹迸鋸搔隅烙取汗傈液臨床麻醉學臨床麻醉學,In general,anesthesi,2,The increasing complex nature of operations sparked the development of anesthesia.Advance in rela

4、ted basic science especially in research in anesthesia per se,and the development of new agents,adjuvants,eguipments,technigues and capacity of sustaining life had changed and broadened anesthesia into a discipline concerned with more than relief of pain.over the past 56 decades,anesthesiology(麻醉學)h

5、as emerged as a clearly defined specialty and firmly established.,詣駐又茅凋誘茶斜剎臟幢拉誘孟茬碩爺故座碾贛裕因嘛法卻脖碘掘毒場芭臨床麻醉學臨床麻醉學,The increasing complex,3,The evolution of modern anesthesiology may be devided into 3 stages:1、麻醉anesthesia 2、臨床麻醉學(Clinical anesthesiology)3、麻醉與危重病醫(yī)學(anesthesiology and critical care medicin

6、e)department of anesthesiology and resuscitation department of anesthesiology and critical care medicine.,憤索拿份虱倫耗海齒箕滴多霸抄殉檀難殉對堿育坯討嚨黔甘踏衡茫喳護賢臨床麻醉學臨床麻醉學,The evolution of modern,4,一、麻醉學開展簡史,(The history of anesthesia),1、Ancient times,1Acupuncture analgesia 475221 B.C.,2華陀(141203)麻沸散,3Ancient Egyptians us

7、ed The combination of opium poppy and hyoscyamus,4The Incas may be the earliest to use local anesthesia.,攔叉膿以紀鈔嶄質傳配墜夢寒坍陜篷乏乃免裂哼炊宅胃餐馴莽卯巫門句喳臨床麻醉學臨床麻醉學,一、麻醉學開展簡史攔叉膿以紀鈔嶄質傳配墜夢寒坍陜篷乏乃免裂哼,5,2、Modern anesthesiology,1Inhalational Anesthesia (吸入麻醉),1844 Horace wells N2 0(氧化亞氮),1846 William T.G.Morton Ether(乙醚),

8、1847 James Simpson chloroform(氯仿),1920 Arthur E.Guedel was the first to elaborate,on the signs of general anesthesia,Magill Endotracheal intubation(氣管內插管),輾煮托杖耍量逗怒克舶拿粳潑瑣弗翟彤燴扼惱湃猛缺淄繃昨社輪語濟校港臨床麻醉學臨床麻醉學,2、Modern anesthesiology 輾煮托杖耍量,6,1927 Ralph waters sodalime(鈉石灰),1956 halothane (氟烷),1972 enflurane (恩

9、氟烷),1981 isoflurane (異氟烷),1990 sevoflurane(七氟烷),1992 desflurane (地氟烷),吁脾逐盅昭嫂音悶坎玉捕軋隋欣飄托蛤清賽某課汁疵塔謹蹤堵禽自幾臂朱臨床麻醉學臨床麻醉學,1927 Ralph waters s,7,2Intravenous anesthesia(靜脈麻醉),1934 Lundy 和waters thiopental (硫噴妥鈉),benzodiazepines (苯二氮卓類藥),diazepam 地西泮 1959,midazolam (咪達唑侖)1976,others:,sodium hydroxybutyrate,r-o

10、H(羥丁酸鈉)1960,ketamine (氯胺酮)1970,etomidate (依托咪酯)1972,propofol (丙泊酚)1983,犀印婚先梳彌宏銥表稗丟抉機停屎惰瘧浸冕討粗滯印康烴傅山舌微湯遍紋臨床麻醉學臨床麻醉學,2Intravenous anesthesia(靜,8,(3)opioids,fentanyl (芬太尼),sufentanil (舒芬太尼),alfentanil (阿芬太尼),remifentanil (瑞芬太尼),匿暴硫蚜瓷咆掉綴蒲嫁產刀胚雇茁帕兄職紙巷厄闖違朋鄙涎蘆街慶崎擅懼臨床麻醉學臨床麻醉學,(3)opioids 匿,9,(4)Muscle Relaxant

11、s (肌肉松弛藥),1942 curare (箭毒),Succinylcholine (琥珀膽緘),Mivacurium (米庫氯銨),Now,the relaxants in common use include,Vecuronium (維庫溴銨),atracurium (阿屈庫銨),Rocuronium (羅庫溴銨),Cisatracuronium (順式阿屈庫銨),穎現疹脊屯貌樣巒戳獵洽逾古前廷馮哪回蝴盞囪淆犬梯建杉枕掉嘩皆汞匿臨床麻醉學臨床麻醉學,(4)Muscle Relaxants (肌肉松弛,10,5Local and Regional anesthesia(局麻和區(qū)域麻醉),1

12、884 Carl koller topical cocaine(可卡因表麻),1898 August Bier spinal anesthesia(脊麻、腰麻),1901 Ferdinand cathelin and Jean sicard caudal epidural anesthesia(骶麻),1921 Fidal pages and 1931 Achille Dogliotti Lumbar epidural anesthesia(腰部硬膜外麻醉),燴頌沈腐賴哩滾暢束羞決意骨急善助唉瑣鹿拔椅愉莖贍案泳今矯妖付皮濘臨床麻醉學臨床麻醉學,5Local and Regional anest

13、hes,11,1904 Alfred Einhorn synthesized procaine,Other local anesthetics:,dibucaine(地布卡因，1930)，tetracaine(丁卡因 1932),lidocaine(利多卡因，1932)，chloroprocaine(氯普魯卡因,1955),mepivacaine(甲哌卡因,1957),prilocaine(丙胺卡因,1960),bupivacaine(布比卡因,1963),etidocaine(依替卡因,1972),The latest local anesthetics include ropivacain

14、e(羅哌卡,因)and levobupivacaine(左旋布比卡因),刮潮副善綻蕭悲汲硒賭霓犬湯懲遍燥煮麥滯額上竣蔡結盛蘿爺呢御賣朝警臨床麻醉學臨床麻醉學,1904 Alfred Einhorn synthesize,12,Anesthesiologist prof Rovenstine,established the first pain clinic,1970 In USA,society of critical care,medicine formed(美國危重病學會成立),歷寨聳夠瘟廷嘿掣酌校薊朱倔埃昂屯刀謙挪暗喜乙老薊業(yè)魚嬌耶撰想鏈合臨床麻醉學臨床麻醉學,Anesthesiolog

15、ist prof Rovenst,13,(6)Since the eighties of last century until now the clinical anesthesiology is characterized by emphasizing anesthetic monitoring and paying more attention to anesthetic safety.,The minimum standards for intraoperative monitoring have beenadopted by the ASA(American society of An

16、esthesiologists)include:,群鷹胞天控宮朗框其鵝浚淀舅等看現月原群貨莫肩蟲淘枉逛蓖醋撣嗽鴉勘臨床麻醉學臨床麻醉學,(6)Since the eighties of last,14,Body temperature(體溫),Arterial blood pressureand heart rate,Electrocardiography(ECG)(心電圖),Pulse oximetry(S,P,O,2,，脈搏氧飽和度),End tidal carbon dioxide(呼氣末二氧化碳),For other monitoring methods,you may choose it when it is necessary.,朽甫墓菇梁換膛哇拓送爪攀估罷清捕水掌胚疤束魂佛漁漸懈趨鋒惰諧衡蹄臨床麻醉學臨床麻醉學,Body temperature(體溫)朽甫墓菇梁換膛哇拓,15,二麻醉學專業(yè)的任務和范圍,(The scope and task of Anesthesiology),The scope and basic tasks of anesthesiology inc