第108章 ?术前麻醉评估(1 / 2)

九星医院 明心飞扬 0 字 2021-09-05

患者林大田的麻醉等级是asa-2级,属麻醉风险较低的级别。

花旗国麻醉医师协会(asa)于麻醉前根据病人体质状况和对手术危险性进行分类,共将病人分为六级。

第一级:体格健康,发育营养良好,各器官功能正常。围手术期死亡率0.06%-0.08%;

第二级:除外科疾病外,有轻度并存病,功能代偿健全。围手术期死亡率0.27%0.40%;

第三级:并存病情严重,体力活动受限,但尚能应付日常活动。围手术期死亡率1.82%-4.30%;

第四级:并存病严重,丧失日常活动能力,经常面临生命威胁。围手术期死亡率7.80%-23.0%;

第五级:无论手术与否,生命难以维持24小时的濒死病人。围手术期死亡率9.40%-50.7%;

第六级:确证为脑死亡,其器官拟用于器官移植手术。

一、二级病人麻醉和手术耐受力良好,麻醉经过平稳。

三级病人麻醉有一定危险,麻醉前准备要充分,对麻醉期间可能发生的并发症要采取有效措施,积极预防。

四级病人麻醉危险性极大,即使术前准备充分,围手术期死亡率仍很高。

五级为濒死病人,麻醉和手术都异常危险,不宜行择期手术。

贾水冰介绍完手术方案和麻醉方案后,看向张景。

张景则看向韩秀妍,“韩院,你的意见是”

贾水冰列了四个麻醉方案,并把要点简单罗列出来了,并作了选择,因此他说或不说,对手术方案的最终确定也没太大影响。

韩秀妍一点都不怯场地说道,“在局部麻醉和全身麻醉的两种方式之中,我建议选择全身麻醉。”

“局部麻醉中的椎管内阻滞虽然也可运用到术中,其好处是手术部位在左下腹部,阻滞平面达t6-t4可基本满足手术要求,手术创面加局麻可有效抑制内脏牵拉反射。”

“但是直肠部位血运丰富,预计术中出血量较大;淋巴清扫时,迷走神经阻滞不完善,容易引起消化系统、循环系统的问题;所以不宜选择局部麻醉。”

全身麻醉简称全麻,是指麻醉药经呼吸道吸入、静脉或肌肉注射进入体内,产生中枢神经系统的暂时抑制,临床表现为神志消失、全身痛觉消失、遗忘、反射抑制和骨骼肌松弛。

临床上常用的全身麻醉方法有吸入麻醉、静脉麻醉和复合麻醉。

“吸入麻醉,以喉罩输送麻醉药物并维持术中通气的方式适用于体型偏瘦的患者,而这个患者体重约75公斤,体形偏胖,另外术中正压通气时有漏气的可能,手术时间又长,喉罩要是移位的话,会影响麻醉稳定,所以不太建议做单纯的吸入麻醉!”

“静脉麻醉虽然具有诱导快、操作简便且可避免吸入麻醉药引起的环境污染等优势,但麻醉的深度缺乏明显的标志,给药时机较难掌握,预计这次手术时间较长,如果术中麻醉突然减浅,容易引起术中患者清醒的问题。”

“建议选择静吸复合全身麻醉,采用先吸入诱导、静脉维持、辅以气管内插管通气的的方法,在静脉麻醉减浅时,间断吸入挥发性麻醉药,这样既可维持麻醉深度的相对稳定,又可减少吸入麻醉药的用量,有利于麻醉后迅速苏醒!”

“我说完了!”

贾水冰和助手们面面相觑,你韩秀妍都说得这么详细了,我们讨论什么呢

张景朝贾水冰说道:“给患者再做一次麻醉评估,患者年纪大,风险蛮高,别搞得下不了台!”

“好的!”

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