口腔领面麻醉.pptxVIP

口腔领面麻醉;教学大纲;第一节　口腔 颌面外科病人与手术特点及麻醉处理;一、常见口腔腭面外科病人的解剖及生理改变;3) 口腔肿瘤 Oral tumor 　　 如肿瘤侵袭到咽、软腭、口底和翼腭韧带，不仅张口困难，也阻塞咽部，使气管插管难以施行，且常伴有低氧血症 4) 口腔及颌面部外伤 Trauma 　　 如波及软腭、咽旁、舌根及舌底，不仅组织肿胀使咽部变窄，也极易形成血肿阻塞咽部 　　 上或下颌骨骨折的变形移位，可引起脱位性窒息 ;5) 颌－胸、颌－ 颈粘连 Mandible-thorax, mandible-neck adherence 　　头颈部呈固定状态，使头部极度前屈，喉头明显移位，气管也随粘连瘢痕移向左侧或右侧，使病人不能仰头，也无法行气管造口 6) 口周瘢痕挛缩病人 scar formation and contractions around the mouth ，使口裂极度变小，病人根本无法张口，喉镜与气管导管难以进入口腔　 7) 小下颌病人 Congenital maxillofacial deformity 　　舌体位于较小的下颌腔内，并且此类病人的声门位置较高，使气管插管困难;二、口腔颌面外科手术的特点Characteristics of the surgery ;三、针对手术特点进行的麻醉处理How to deal with the mentioned problems ; To fix the tracheal tube and connecting tube in position, protect the anaesthetic tubing from dislodgement 　　此外，为防止导管在弯曲时管腔折屈或压偏，最好采用管壁带细金属丝或尼龙丝做管壁支架的导管 Choose an appropriate intubation route nasal intubution Oral intubution ;Hypotension technique 　　Use this technique in important procedure. The hypotensive duration should be short SBP90mmHg, MBP60mmHg To fulfil respiration self-regulation, the postoperative resuscitation should be quick Prevent postoperative nausea and vomiting-related to pharyngeal stimulation, postoperative pain, anesthetic drugs etc;第二节　麻醉选择及常用麻醉方法The anesthetic choices and common anesthetic methods;第三节　麻醉管理与麻醉后处理Management during and after anesthesia;The criteria of satisfied ventilation: SpO2 98-100% PET CO2 30-45mmHg Blood-gas analysis TV 8-10ml/kg (Neonate 6-7ml/kg) Rf 12/min (Neonate Rf ) ;(二)Management after anesthesia;Delayed extubation: ① Pharyngeal damage due to tracheal intubation ② The involved operation range is large ③ Restrictive dressings（敷料） applied after surgery　 ④ Narrowed pharyngeal cavity due to trauma ;(2) Prevent postoperative nausea and vomiting (3) Prevent the complications related to anesthesia Nasal-pharyngeal mucosal haemorrhage（鼻咽粘膜出血） Nasal-pharyngeal mucosal fall off Pharyngeal edema ;（4）Postoperative maxilla sinus（颌窦） inflammation;感谢观看！