手术麻醉前病人的准备 ppt课件.ppt

手术麻醉前病人的评估与准备
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博兴县人民医院麻醉科王明安
手术麻醉前准备的目的
使病人在体格和精神两方面均处于可能达到的最佳状态,以增强病人对麻醉和手术的耐受能力,提高病人在麻醉中的安全性,避免麻醉意外的发生,减少麻醉后的并发症。
,评定全身情况及分级
,需要做哪些准备及处理
,采取什么样的预防措施,选择合适的麻醉方法。
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手术前病情估计分级
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ASA手术病人病情分级
ASA Class
Conditions
Examples
Ⅰ
Normal Healthy Patient
No Underlying Disease
Elective Surgery; OVH, Castration, Declaw.
Ⅱ
Mild to Moderate Systemic Disturbance. Able pensate.
Neonatal and Geriatric Animals. Controlled Diabetes, Simple Fracture, Obesity.
Ⅲ
Moderate to Severe Systemic Disturbance due to a Surgical or Medical Disease.
Moderate Anemia, Cachexia, Fever, Renal Disease, Cardiac Disease.
Ⅳ
Severe Systemic Disturbance.
Shock, Uremia, Toxemia, Gastric Torsion, Colic, Hemorrhage. Animal not expected to live 24 hours without surgery.
Ⅴ
Moribund atose Patients.
Advanced Disease. Solitary or an failure. Animals with little chance of survival.
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手术病人全身情况分级
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对Ⅰ类病人,应调整和维护全身情况及重要器官功能,最大程度增强病人对麻醉的耐受力
对Ⅱ类病人,除需做好一般性准备外,还必须根据各别情况做好特殊准备
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手术麻醉前一般准备精神状态准备
情绪激动或彻夜失眠可导致中枢神经或交感神经系统过度活动,削弱对麻醉和手术的耐受力,术中术后容易出现休克
术前须解除思想顾虑和焦急情绪,。取得信任,争取合作
过度紧张不能自控的病人,术前可服用适量安定类药
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禁食、禁饮规则示例
Age
Solids and Non-clear Liquids
Clear Liquids
Adults
6 ~ 8h or none after midnight
2 ~ 3h
Children older than 36 months
6 ~ 8h
2 ~ 3h
Children aged 6 to 36 months
6h
2 ~ 3h
Children younger than 6 months
4 ~ 6h
2h
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