老年心脏病人非心脏手术麻醉课件.pptVIP

老年心脏病人非心脏手术麻醉二、麻醉前用药（1）咪达唑仑0.05mg/kg术前1h肌注。（2）东茛菪碱0.3mg术前1h肌注，心动过缓者改用阿托品0.4mg肌注。（3）哌替啶0.5～1mg/kg术前1h肌注。老年心脏病人非心脏手术麻醉三、麻醉前准备1必要的检查（1）病史和体检（2）心电图（3）超声心动图（4）冠状动脉造影（5）实验室检查2.必要的准备（1）内科治疗①心律失常；②高血压；③改善心脏功能。（2）纠正水、电解质和酸碱紊乱，特别应纠正低血钾。（3）急症手术尽可能完成上述一些准备,同时在有限的时间内进行心电图、血气和电解质检查，处理心律失常（如快速房颤）或心力衰竭。老年心脏病人非心脏手术麻醉四、麻醉选择和应用1.椎管内阻滞主要用于骨科和泌尿外科手术，常选连续硬膜外阻滞，优点为阻滞范围可控制，对血压影响缓和，术后可保留导管镇痛，有利于减少术后心、肺并发症。*Whenyouseeapreoppatient,theveryfirstquestionyouaskyourselfis:isthisanemergentsurgeryforlife-threateningpathology?Ifitis,thenproceedthesurgeryandpostoperativeriskstratificationandmanagementmaybeappropirate.Ontheotherhand,ifthesurgeryisnotaurgentone,weshouldproceedtostep2evaluation.*Thenestquestionweaskiswhetherthepatienthadacoronaryrevascularizationwithinpast5yearsandmoreimportantly,whetherpatientissymptomfree.Ifanswerisyes,thenproceedthesurgery.Step3,toaskquestionifpatienthadarecentcoronaryevaluations,andifanswerisyeswithoutactiveischemia,weshouladalsoproceedthesurgerywithoutfurtherstudy.Ifpatientdoesn’thaveneitherofthem,thenweproceedtostep4and5.*Step4:ifapatienthasmajorclinicalpredictorsandwoithoutanycoronaryworkuportreatment,hissurgeryshouldbedelayedforfurthercardiacworkup.Forpatientswithintermediateorminorclinicalpredictors,gotostep6or7.*Nowwecontinueonthealgorithm,step6forpatientswithintermediateclinicalpredictorsbyassessingtheirfunctionalcapacity:Iftheirfunctionalcapacityispoor,ormoderatefunctionalcapacitybutwillundergoahighrisksurgery,theircardiacfunctionshouldbeassessedbeforegoingintoOR.*Thosepatientswhohaveminorornoclinicalpredictors,poorfunctionalcapacityandundergoinghighriskprocedureshouldhavecardiacworkbeforesurgery.*Tosummerize,whenweperformpreopcardiacevaluationofapat