《临床麻醉学》PPT课件.ppt
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1、临床麻醉学 (Clinical Anesthesiology) 绪论 (Introduction),The term “anesthesia”( 麻醉) is derived from Greek Word, it means “lack of feeling or sensation ” or“privation of senses ” im plying lack of appreciation. The usual concept for anesthesia relates primarily to the prevention of pain perception during an
2、 operation or an invasive procedure . But , this concept is out of date now.,In general , anesthesia can be defined as a drug-induced or physical factors-induced state of reversible functional depression of part of the central nervous system or peripheral nervous system,which is characterized by los
3、s of sensation ,especially pain perception .,The increasing complex nature of operations sparked the development of anesthesia . Advance in related basic science especially in research in anesthesia per se ,and the development of new agents ,adjuvants , eguipments, technigues and capacity of sustain
4、ing life had changed and broadened anesthesia into a discipline concerned with more than relief of pain . over the past 56 decades ,anesthesiology(麻醉学) has emerged as a clearly defined specialty and firmly established .,The evolution of modern anesthesiology may be devided into 3 stages : 1、麻醉(anest
5、hesia) 2、临床麻醉学(Clinical anesthesiology) 3、麻醉与危重病医学(anesthesiology and critical care medicine) department of anesthesiology and resuscitation department of anesthesiology and critical care medicine .,一、麻醉学发展简史 (The history of anesthesia ) 1、Ancient times (1)Acupuncture analgesia 475221 B.C. (2)华陀(141
6、203 )麻沸散 (3)Ancient Egyptians used The combination of opium poppy and hyoscyamus (4)The Incas may be the earliest to use local anesthesia .,2、Modern anesthesiology (1)Inhalational Anesthesia (吸入麻醉) 1844 Horace wells N2 0 (氧化亚氮) 1846 William T.G. Morton Ether (乙醚) 1847 James Simpson chloroform(氯仿) 19
7、20 Arthur E. Guedel was the first to elaborate on the signs of general anesthesia Magill Endotracheal intubation (气管内插管),1927 Ralph waters sodalime (钠石灰) 1956 halothane (氟烷) 1972 enflurane (恩氟烷) 1981 isoflurane (异氟烷) 1990 sevoflurane (七氟烷) 1992 desflurane (地氟烷),(2)Intravenous anesthesia (静脉麻醉) 1934
8、Lundy 和waters thiopental (硫喷妥钠) benzodiazepines ( 苯二氮卓类药 ) diazepam (地西泮) 1959 midazolam (咪达唑仑) 1976 others: sodium hydroxybutyrate , r-oH (羟丁酸钠)1960 ketamine (氯胺酮) 1970 etomidate (依托咪酯) 1972 propofol (丙泊酚) 1983,(3) opioids fentanyl (芬太尼) sufentanil (舒芬太尼) alfentanil (阿芬太尼) remifentanil (瑞芬太尼),(4) M
9、uscle Relaxants (肌肉松弛药) 1942 curare (箭毒) Succinylcholine (琥珀胆缄) Mivacurium (米库氯铵) Now , the relaxants in common use include Vecuronium (维库溴铵), atracurium (阿屈库铵) Rocuronium (罗库溴铵) Cisatracuronium (顺式阿屈库铵),(5)Local and Regional anesthesia (局麻和区域麻醉) 1884 Carl koller topical cocaine (可卡因表麻) 1898 August
10、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),1904 Alfred Einhorn synthesized procaine Other local anesthetics: dibucaine(地布卡因,1930),tetracaine(丁卡因 1932) lidocain
11、e(利多卡因,1932),chloroprocaine(氯普鲁卡因,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 ropivacaine(罗哌卡 因)and levobupivacaine(左旋布比卡因),Anesthesiologist prof Rovenstine established the first pain clinic 1970 In USA, societ
12、y of critical care medicine formed(美国危重病学会成立 ),(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 been adopted by th
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