Nima uchun umumiy behushlik kiritilgandan keyin bemorlarda og'ir gipotenziyani keltirib chiqarish oson

Kombinatsiyalangan behushlik

Kombinatsiyalangan behushlik so'nggi yillarda mashhur anesteziya usuli hisoblanadi. Kombinatsiyalashning ko'plab usullari mavjud, masalan: epidural-orqa miya behushligi (CSE), epidural{1}}umumiy behushlik, o'murtqa anesteziya-umumiy behushlik, servikal pleksus-umumiy behushlik , umumiy behushlik-lokal behushlik (Ilohiy yoki ortopedik).

①CSE

CSE ignasining ixtirosi bu usulni sodda va oson ishlaydi. Epidural bilan birlashtirilgan o'murtqa anesteziyaning asosiy afzalligi, o'murtqa behushlik vaqtini cheklashning kamchiliklarini to'ldirish va operatsiyadan keyingi PCEA sedasyonini davom ettirish uchun tez boshlangan, to'liq blokirovka va mushaklarning yaxshi gevşemesi va doimiy epidural blokirovka bilan o'murtqa anesteziyaning xususiyatlarini qo'llashdir. og'riq. CSE usulining kamchiligi shundaki, operatsiya texnikasi murakkab va o'murtqa behushlikdan keyin gipotenziya paydo bo'lishiga moyil. Pekin universitetida birinchi katta miqdordagi klinik amaliyotga ko'ra, to'g'ri operatsiya usullari o'zlashtirilgan ekan, CSE nafaqat sog'lom bemorlar, balki homilador ayollar va keksa bemorlar uchun ham qo'llanilishi mumkin. Men gipobarik o'murtqa behushlik ({0}},15 foizdan 0,25 foiz bupivakain) tufayli kelib chiqadigan gipotenziya darajasi giperbarik suyuqlikka qaraganda ancha past ekanligini his qildim. Bundan tashqari, yurak-qon tomir funktsiyasi yomon kompensatsiyalangan bemorlarga birinchi navbatda past darajadagi o'murtqa behushlik (1/2 dan 2/3 dozada o'murtqa behushlik) qo'llanilishi mumkin va epidural behushlik asta-sekin etishmovchilikni to'ldirish uchun qo'llaniladi. behushlik diapazoni. Albatta, CSE dan oldin-oldindan infuziya, kerakli hajmni kengaytirish, tayyor atropin va efedrin va kislorod bilan ta'minlash KSE gemodinamik barqarorligini ta'minlash uchun asosdir.

② Epidural compound general anesthesia

Epidural has good analgesic and muscle relaxation effects. The unconsciousness of general anesthesia eliminates the patient's tension and discomfort, muscle relaxation makes the operation easier, and endotracheal intubation and mechanical ventilation make the patient's cardiopulmonary function more controllable; the combination of the two methods The need for epidural local anesthesia is significantly reduced, while shallow general anesthesia can meet the requirements, which greatly improves the safety of anesthesia. Therefore, it is the most respected anesthesia method in our hospital so far; this method is especially suitable for the elderly, severe and large. Anesthesia of the patient. Attention should be paid to this anesthesia: induction of general anesthesia on the basis of epidural block can lead to severe hypotension and/or bradycardia. In this case, attention should be paid to staggering the peak of induction of epidural and general anesthesia. Anesthesia is mainly based on epidural or general anesthesia according to needs. For example, epidural anesthesia is generally the main method, and epidural anesthesia should be stopped when blood loss or hypotension occurs.

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