心脏病人麻醉VIP免费

心脏病人的麻醉心脏手术非心脏手术先天性心脏病先天性心脏病((CongenitalHeartDisease)CongenitalHeartDisease)青紫型非青紫型右→左分流左→右分流肺血少肺血多缺氧、酸中毒血容量获得性心脏病(AcquiredHeartDisease)瓣膜病变的程度二尖瓣4-6cm2主动脉瓣2.6-3.5cm2≤2.1cm2＞10Torr≤1cm2心肌收缩力损害的程度EF、PH、CVP合并其他脏器病变的程度二尖瓣狭窄二尖瓣关闭不全LVPHRV避免窦速、房颤快室率突然心率变慢低血容量突然外周阻力增加过度输液头低位、心肌抑制低外周阻力低血容量低氧、低通气主动脉瓣狭窄主动脉关闭不全晕厥心绞痛心力衰竭避免心动过缓心动过缓(>80次/分)低血容量突然增加外周阻力突然外周阻力改变心肌抑制缺血性心脏病缺血性心脏病((ischemicHeartdisease)ischemicHeartdisease)心室功能的判断病史：活动度、心绞痛、心肌梗塞、心力衰竭药物检查：心电图、心胸比例心室功能心室功能好差EF>60%<40%PAWP<12>18CI>2.8<2.1LVG－HypokinesiadyskinesiaakinesiaaneurysmMI－+CAG－LMLAD，CX，RCADM，HT，SmokingCardiacAnesthesiaPremedicationMorphine10mgScopolamine0.3mgInductionFentanyl3-8g/kg10-20g/kgMidazolam0.02mg/kgEtomidate0.3mg/kgPancuroniumPipecuriumVecuroniumMaintenanceIsofluraneEnfluraneFentanylMonitoringABPCVPPAWPCISpO2ETCO2ABGK+MyocardiacProtectionCardioplegiaHypothermiaCrystalloidBloodRetrograde5-11℃K+15-40mEq/LLowCardiacOutputBP<80CVP>15PAWP>18SVRI>2500CI<2.1UO<0.5ml/kg·minUnconsciousnessTreatmentPreloadCVP10PAWP15AfterloadNP0.15-10ug/kg·minNTGContractilityDopamine4-6ug/kg·minEpinepherine1-4ug/minDobutamine4-6ug/kg·minAmrinone0.5-1mg/kg5-10ug/kg·minAntiarrhythmiaLidocaine1-1.5mg/kg1-4mg/minVerapamil2.5-10mgDiltiazem0.15mg/kg2ug/kg·minAmiodarone150mg/20min1,200mg/24hrsIsoprerolol1-4ug/min围术期心肌缺血心肌氧供需失衡冠脉痉挛血栓形成血氧含量前负荷NO冠脉血流量后负荷NTG心率心肌收缩力Diltiazem舒张末压心率AprotinineAspirin