,*,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),臨床麻醉學(xué)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relates primarily to the prevention of pain perception during an operation or an invasive procedure.But,this concept is out of date now.,In general,anesthesia can be defined as a drug-induced or physical factors-induced state of reversible functional depression of part of the central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 loss 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 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(xué))has emerged as a clearly defined specialty and firmly established.,The evolution of modern anesthesiology may be devided into 3 stages:1、麻醉anesthesia 2、臨床麻醉學(xué)(Clinical anesthesiology)3、麻醉與危重病醫(yī)學(xué)(anesthesiology and critical care medicine)department of anesthesiology and resuscitation department of anesthesiology and critical care medicine.,一、麻醉學(xué)開展簡(jiǎn)史,(The history of anesthesia),1、Ancient times,1Acupuncture analgesia 475221 B.C.,2華陀(141203)麻沸散,3Ancient Egyptians used The combination of opium poppy and hyoscyamus,4The Incas may be the earliest to use local anesthesia.,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),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(nèi)插管),1927 Ralph waters sodalime(鈉石灰),1956 halothane (氟烷),1972 enflurane (恩氟烷),1981 isoflurane (異氟烷),1990 sevoflurane(七氟烷),1992 desflurane (地氟烷),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(dá)唑侖)1976,others:,sodium hydroxybutyrate,r-oH(羥丁酸鈉)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)Muscle Relaxants (肌肉松弛藥),1942 curare (箭毒),Succinylcholine (琥珀膽緘),Mivacurium (米庫(kù)氯銨),Now,the relaxants in common use include,Vecuronium (維庫(kù)溴銨),atracurium (阿屈庫(kù)銨),Rocuronium (羅庫(kù)溴銨),Cisatracuronium (順式阿屈庫(kù)銨),5Local and Regional anesthesia(局麻和區(qū)域麻醉),1884 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),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 ropivacaine(羅哌卡,因)and levobupivacaine(左旋布比卡因),Anesthesiologist prof Rovenstine,established the first pain clinic,1970 In USA,society of critical care,medicine formed(美國(guó)危重病學(xué)會(huì)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 beenadopted by the ASA(American society of Anesthesiologists)include:,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.,二麻醉學(xué)專業(yè)的任務(wù)和范圍,(The scope and task of Anesthesiology),The scope and basic tasks of anesthesiology include:,1.Clinical anesthesiology,(1).To perform preanesthetic visit and evalualion,and to formulate anesthetic plan.Taking part in the preanesthelic preparation.,(2).To render patients insensible to pain and discomfort and keep the stress responseat suitable level.,(3).To monitor the patients during operations,and to regulateor control the importaut physiological functions of the patients in order to provide maximum safety for the patients and to provide optimal operative conditions for surgeons.,(4).To prevent and treat anesthetic complications,(5).To monitor and treat patients in postanesthesia care unit(PACU),2.First aid and resuscitation(急救與復(fù)蘇),3.Critical care medicine(CCM,危重病醫(yī)學(xué)),(intensive care medicine,也稱加強(qiáng)醫(yī)學(xué)),Its clinical position is called Intensive care unit,ICU(重癥監(jiān)測(cè)治療病室或加強(qiáng)醫(yī)療病室),4.Pain management and its relatcd researeh epically the mechanism of pain,5.Research,teaching and training,三如何學(xué)好麻醉學(xué),(How to learn anesthesiology),1.To combine basic medical sciences with clinical medicine(根底與臨床結(jié)合),2.To combine theory with practice(理論與實(shí)踐結(jié)合),Anesthesiologist o