麻醉与器官保护课件.ppt
- 【下载声明】
1. 本站全部试题类文档,若标题没写含答案,则无答案;标题注明含答案的文档,主观题也可能无答案。请谨慎下单,一旦售出,不予退换。
2. 本站全部PPT文档均不含视频和音频,PPT中出现的音频或视频标识(或文字)仅表示流程,实际无音频或视频文件。请谨慎下单,一旦售出,不予退换。
3. 本页资料《麻醉与器官保护课件.ppt》由用户(晟晟文业)主动上传,其收益全归该用户。163文库仅提供信息存储空间,仅对该用户上传内容的表现方式做保护处理,对上传内容本身不做任何修改或编辑。 若此文所含内容侵犯了您的版权或隐私,请立即通知163文库(点击联系客服),我们立即给予删除!
4. 请根据预览情况,自愿下载本文。本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
5. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007及以上版本和PDF阅读器,压缩文件请下载最新的WinRAR软件解压。
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 麻醉 器官 保护 课件
- 资源描述:
-
1、Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Anesthesia&Organ Protection 麻醉与器官保护 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Organ Function 器官功能 Time时间 Effects of Anaesthesia on Organ Function 麻醉对于器官功能的影响麻醉对于器官功能的影响 Liver肝脏 Kidney Gut 肾脏,消
2、化道 Vascular resistance 血管阻力 Contractility 收缩力 Respiration 呼吸 Consciousness 意识 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Are the effects reversible-e.g.brain?这些影响可逆转吗 例如:脑?Organ Function 器官功能 Time时间 Eye opening睁眼 Orientation定向 Emotional情感 Cognitive认知 Anaesthesia and P
3、ain Management Unit;Cardiovascular Therapeutics Unit H.au Recovery differences-other organs 恢复的差别 其他器官 Organ Function 器官功能 Time时间 Respiratory 呼吸 Cardiovascular 心血管 Nausea+Vomiting恶心和呕吐 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Range of recovery 恢复的范围恢复的范围 Organ Funct
4、ion 器官功能 Time时间 Expectation 期望值 Range范围 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Can anaesthetics cause harm?麻醉是有害的吗?麻醉是有害的吗?Harm Protection Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Do you practice anaesthesia with the firm belief,t
5、hat when you switch off the anaesthetic,that the effects are fully reversible and that no harm is done to the patients?实施麻醉时您是否坚信在停药后麻醉药物的影响是否可以完全逆转而对病人没有伤害?Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au If you said yes then why do we get 如果你的回答是“YES”,那么为什么我们还会遇到.?prolong
6、ed nausea and vomiting 术后长时间的恶心和呕吐?agitation躁动?disorientation定向障碍?postoperative cognitive dysfunction(POCD)术后认知功能障碍?sometimes prolonged hypotension有时发生长时间的低血压?cases of good versus bad recovery患者恢复有好有坏 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au What we do know 我们所知的:我们
7、所知的:?Anaesthetics alone can cause POCD in mice after repeated exposure反复使用麻醉药这一单一因素即可导致小鼠术后认知功能的障碍?Anaesthetics can alter hippocampal gene expression lasting weeks,indicating that longer term intracellular changes occurs麻醉药能够持续数周改变海马基因的表达,提示发生了远期的细胞内改变 Bianchi SL,Tran T,Liu C et al.Brain and behavio
8、r changes in 12-month-old Tg2576 and nontransgenic mice exposed to anesthetics.Neurobiol Aging 2007.Culley DJ,Yukhananov RY,Xie Z et al.Altered hippocampal gene expression 2 days after general anesthesia in rats.Eur J Pharmacol 2006;549:71-8.Anaesthesia and Pain Management Unit;Cardiovascular Therap
9、eutics Unit H.au What we dont know-what is the trigger for harm 我们不知道的 导致伤害的诱因是什么??Drug药物?Dose剂量?Depth麻醉深度?Duration用药时间?Repeated exposure反复用药?Patient susceptibility病人的易感性?Importance of co-morbidities并存疾病的重要性?Are all anaesthetics equal?所有的麻醉药都一样吗?Anaesthesia and Pain Management Unit;Cardiovascular Th
10、erapeutics Unit H.au Are all anaesthetics all equal?所有的麻醉药都一样吗?Harm 伤害 Protection 保护 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au We should not assume that all anaesthetics are equal,nor should we assume that all drugs from the same class are the same既不能假设所有的麻醉药是一样的,也不应
11、该假既不能假设所有的麻醉药是一样的,也不应该假设同类药物中所有的药是相同的设同类药物中所有的药是相同的 Harm Protection?Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Example-effect on contractility 举例 对心肌收缩力的影响 Royse CF,Liew DF,Wright CE et al.Persistent depression of contractility and vasodilation with propofol but not w
12、ith sevoflurane or desflurane in rabbits.Anesthesiology 2008;108:87-93 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Example-effect on MAP 举例 对平均动脉压的影响 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Concept of organ protection 器官保护的概念器官保护的概念?R
13、equires a potential organ injury存在潜在的器官损害因素 Ischaemia and reperfusion 缺血和再灌注 Trauma创伤 Chemical/drug toxicity 化学/药物毒性?Different organs may have different effects对不同的器官可能有不同的影响 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Model of organ protection Drugs with no organ prot
14、ection 器官保护药物本身并无直接的器官保护作用:模型说明 Organ Function 器官功能 Time时间 Organ Insult器官损伤 Drug that causes Harm造成伤害的药物 Drug with minimal Harm造成伤害很小的药物 Perceived organ protection 表现出(相对的)器官保护作用 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Organ protection器官保护器官保护 Organ Function 器官功能 T
15、ime时间 Organ Insult器官伤害 Actual Organ Protection 实际的器官保护 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Organ protection 器官保护 Harm 伤害 Protection 保护 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Mechanisms 机制 Organ Protection 器官保护 receptor effect
16、s受体效应 stabilize mitochondrial membranes 稳定线粒体膜 preserved membrane integrity保护膜的完整性 lower oxygen consumption 降低氧耗 free radical Scavenging 清除自由基 reduce inflammatory cascades 减轻多级炎症反应 Anaesthesia and Pain Management Unit;Cardiovascular Therapeutics Unit H.au Receptors受体受体?Protective volatiles保护性的(挥发性气体
17、)ATPase K+iNOS dependent Modulation of glutamate transport谷氨酸盐的转运调节 GABA(A)2PK+channels(TREK-1)*Adenosine A1?Protective propofol保护性(丙泊酚)Glutamate uptake 谷氨酸盐的摄取(propofol)Antioxidant action抗氧化反应 Preserves function of Na+/H+exchanger维护Na+/H+泵的功能 GABA(A)Zheng S,Zuo Z.Neuroscience 2003;118:99-106.Heurte
18、aux C,Guy N,Laigle C et al.Embo J 2004;23:2684-95.Liu C,Cotten JF,Schuyler JA et al.Brain Res 2005;1031:164-73.Bickler PE,Fahlman CS.Anesth Analg 2006;103:419-29,table of contents.Zhan X,Fahlman CS,Bickler PE.Anesthesiology 2006;104:995-1003.Haelewyn B,Yvon A,Hanouz JL et al.Br J Anaesth 2003;91:390
展开阅读全文