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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 But , this concept is out of date now.,In general , anesthesia can be defined as a drug-induced or physical factors-induced state of reversible functional depression of part of the central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
13、e ASA (American society of Anesthesiologists) include:,Body temperature(体温 ) Arterial blood pressure and heart rate Electrocardiography (ECG) (心电图) Pulse oximetry (SPO2，脉搏氧饱和度) End tidal carbon dioxide (呼气末二氧化碳) For other monitoring methods, you may choose it when it is necessary.,二麻醉学专业的任务和范围 (The
14、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 discomfor
15、t and keep the stress response at suitable level.,(3).To monitor the patients during operations,and to regulate or 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 preven
16、t and treat anesthetic complications (5).To monitor and treat patients in postanesthesia care unit (PACU),2.First aid and resuscitation(急救与复苏) 3.Critical care medicine (CCM,危重病医学) (intensive care medicine,也称加强医学) Its clinical position is called Intensive care unit, ICU (重症监测治疗病室或加强医疗病室) 4.Pain manag
17、ement and its relatcd researeh epically the mechanism of pain 5.Research ,teaching and training,三如何学好麻醉学 (How to learn anesthesiology),1.To combine basic medical sciences with clinical medicine(基础与临床结合) 2.To combine theory with practice (理论与实践结合) Anesthesiologist on paper; craftsman of anesthesia 3.
18、To learn, to investigate continuously; and to make progress continuously.,四麻醉的分类 (classifications of anesthesia),1.classification of anesthetic technigues (按麻醉方法分类) In a broad sense all types of anesthesia may be classified as either regional or general. But, in China, because of the wide usage and
19、characteristic theoritical basis of epidural and spinal anesthesia, they are put into an independent class called “intravertebral anesthesia”.,Anesthetic technigue may be classified as follows:,General anesthesia(全身麻醉) .inhalational anesthesia (吸入麻醉) .intravenous anesthesia (静脉麻醉) .intramuscular ane
20、sthesia (肌肉麻醉) .rectal anesthesia (直肠麻醉),Lntravertebral anesthesia (椎管内麻醉) .subarachnoid block (蛛网膜下隙阻滞) (spinal anesthesia,脊麻.腰麻) epidural block (硬脊膜外隙阻滞) Some times subarachnoid block and epidural block are also called “neuraxial anesthesia”(神经轴麻醉),Local anesthesia (局部麻醉) topical anesthesia (表面麻醉)
21、 local infiltration (局部浸润麻醉) field block 区域（术野）阻滞 (peripheral) nerve blocks (周围神经阻滞,神经阻滞) intravenous regional anesthesia (静脉局部麻醉) In some textbooks and monographs, nerve blocks, spinal anesthesia and epidural anesthesia are collectively called “regional blook” or “regional anesthesia”,Everyday expr
22、essions or terms in common use;,balanced anesthesia (复合麻醉) combined anesthesia (联合麻醉) basal narcosis (基础麻醉） endotracheal anesthesia (气管内麻醉) endotracheal intubation (气管内麻醉) endoBronchial anesthesia (支气管内麻醉),2.1 classifications according to the subspecialty of clinical anesthesiology (接临床麻醉亚学科分类) such
23、 as:. anesthesia for cardiac surgery (心脏手术麻醉) anesthesia for Vascular surgery (血管外科手术麻醉) anesthesia for thoracic surgery (胸科手术麻醉) neurosurgical anesthesia (颅脑外科麻醉) anesthesia for organ transplantation (器官移植手术麻醉),anesthesia for endocrine surgery(内分泌外科麻醉) obstetric anesthesia (产科麻醉) pediatric anesthes
24、ia (小儿麻醉) geriatric anesthesia (老年人麻醉) anesthesia for orthopedic surgery (骨科麻醉) anesthesia for abdominal sugery (腹部外科麻醉) anesthesia for trauma (创伤外科麻醉) and so on,2.2 classifcalions according to the subspecialty of anesthesiology (按麻醉学的亚学科分类) clinical anesthesiology critical care medicine pain management,