吸入麻醉（1）课件

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1、第七章吸入麻醉InhalationalAnesthesia中南大学湘雅医院临床麻醉学教研室一、概述（introduction）1.概念(concept)2.特点(characteristic)可控性好不留任何后遗症二、吸入麻醉药的吸收、分布与消除Uptake,distributionandeliminationofinhalationalanesthetics1、吸收与分布Uptakeanddistribution作用部位:大脑centralnervesystemPAPBPBr动态平衡dynamicequilibrium吸收与分布影响因素：吸入浓度inspiredcon

2、centration分钟通气量minutevolume血/气分配系数blood/gaspartitioncoefficient每分钟肺灌流量perfusionofpulmonary2.消除Elimination●大部分以原形经肺排出Eliminatedmostlyinanunchangedformviathelungs●少部分经肝、肾排出asmallproportionismetabolizedinliverandeliminatedviakidney三、吸入麻醉药的临床评价Clinicalevaluationofinhalationalanesthetics1.可控

3、性controllable●与血/气分配系数有关associatedwithblood/gaspartitioncoefficient2.麻醉强度anestheticpotency●与油/气分配系数有关associatedwithoil/gaspartitioncoefficient●MAC(minimalalveolarconcentration)MACisminimalalveolarconcentrationofaninhalationalanestheticat1atmosphereabsolutethatpreventsmovementsof50%ofthepo

4、pulationtoastandardstimulus.3.对心血管的影响EffectsonCardiovascularsystem●心肌抑制depressionofmyocardialcontractility●增加心肌对儿茶酚胺的敏感性：氟烷IncreasedmyocardialexcitabilityArrhythmiasarecommonduringhalothaneIncreasedcirculatingcatecholamines4.对呼吸的影响Effectsonrespiratory●呼吸抑制Respiratorydepressiondose-depende

5、ntdepressionofventilation●呼吸道刺激irritanttorespiratorydepression●支气管平滑肌舒张relaxationofbronchialsmoothmuscle5.对运动终板的影响Effectsonneuromuscularjunction●肌松作用，增强肌松剂的肌松作用Skeletalmusclerelaxationandpotentiatesnon-depolarizingrelaxants.●安氟醚肌松作用最强Skeletalmusclerelaxationofenfluraneisthegreatestinallin

6、halationalanesthetic.●氟烷对子宫平滑肌松弛作用最强,增加产后出血可能Hatholanerelaxesuterinemuscleandmaycausepostpartumhemorrhage.●增加颅内压，异氟醚影响最小increaseICP,andthisactionofisofluraneisthelowestinallvolatiles.●抑制EEG，安氟醚可引起痉挛性EEG改变Dose-dependentdepressionofEEGactivity,atmoderatetohighconcentration(morethan3%),enflu

7、raneproducesepileptiformparoxysmalspikeactivity.6.对颅内压及EEG的影响EffectsonICPandEEG7.理想吸入麻醉药的特点PropertiesoftheidealinhalationalanestheticPleasantodour,non-irritanttorespiratorydepressionlowblood/solubility—rapidinductionandrecoverfromanesthesiaNeitherflammablenorexplosi