,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,ASA,分级和麻醉前准备,ASA分级和麻醉前准备,ASA,总部网页上有关分级的描述：,ASA Physical Status 1,-A normal healthy patient,ASA Physical Status 2,-A patient with mild systemic disease,ASA Physical Status 3,-A patient with severe systemic disease,ASA Physical Status 4,-A patient with severe systemic disease that is a constant threat to life,ASA Physical Status 5,-A moribund patient who is not expected to survive without the operation,ASA Physical Status 6,-A declared brain-dead patient whose organs are being removed for donor purposes,ASA 总部网页上有关分级的描述：ASA Physical,ASA,ASA PS 1,Normal healthy patient,No organic,physiologic,or psychiatric disturbance;excludes the very young and very old;healthy with good exercise tolerance,ASA,正常健康,患者,没有器官的、生理上的病变以及精神障碍；有健康的体格，很好的运动耐受。不包括婴幼儿及高龄病员。,80,岁,婴幼儿及高龄病员的年龄界定？,ASA ASA PS 1 Normal healt,ASA,ASA PS 2,Patients with mild,systemic disease,No functional limitations;has a well-controlled disease of one body system;controlled hypertension or diabetes without systemic effects,cigarette smoking without chronic obstructive pulmonary disease(COPD);mild obesity,pregnancy,ASA 2,患者有轻度系,统疾病,2,个月以内，或,80,岁以上,无功能限制；某一系统疾病得到良好控制；高血压、糖尿病控制良好且无系统症状；抽烟但无,COPD,；轻度肥胖；妊娠,ASA ASA PS 2Patients with mil,ASA,ASA PS 3,Patients,with severe,systemic,disease,Some functional limitation;has a controlled disease of more than one body system or one major system;no immediate danger of death;controlled congestive heart failure(CHF),stable angina,old heart attack,poorly controlled hypertension,morbid obesity,chronic renal,failure,;bronchospastic disease with intermittent symptoms,ASA 3,患者有,严重系,统疾病,有某些功能限制；一个以上系统疾病并得以控制；并未面临即时死亡威胁；充血性心衰得以控制，稳定型心绞痛，陈旧性心梗，高血压控制不良，病态肥胖，慢性肾衰，间歇症状的支气管痉挛性疾病,ASA ASA PS 3Patients Some f,ASA,ASA PS 4,Patients with severe,systemic disease that is,a constant threat to life,Has at least one severe disease that is poorly controlled or at end stage;possible risk of death;unstable angina,symptomatic COPD,symptomatic CHF,hepatorenal failure,ASA 4,患者有严重系统疾病经常面临死亡威胁,至少有一种未得到控制的严重疾病或其终末期；可能面临死亡危险；不稳定型心绞痛，有症状,COPD,，有症状的充血性心衰，肝肾衰竭,ASA ASA PS 4Patients with sev,ASA,ASA PS 5,Moribund patients who are not expected to survive without the operation,Not expected to survive 24 hours without surgery;,imminent risk of death;multiorgan failure,sepsis,syndrome with hemodynamic instability,hypothermia,poorly controlled coagulopathy,ASA 5,不做手术必死,的垂危患者,不做手术难以存活,24,小时；近在咫尺的死亡威胁，多器官功能衰竭，脓毒症伴有血流不稳，低体温以及凝血障碍（,DIC,）,ASA ASA PS 5Moribund patients,ASA,ASA PS 6,A declared brain-dead patient who organs are being removed for donor purposes,ASA 6,等着捐赠器官的脑死亡病员,ASA ASA PS 6A declared brain-,麻醉前准备,麻醉科医师在任何地点实施任何麻醉,(,包括,局麻镇静监测,),，都必须按一定顺序依次完,成所有麻醉前准备工作。,麻醉机的准备,监护仪的准备,插管用具的准备,药品的准备,特殊耗材和设备的准备,麻醉前准备 麻醉科医师在任何地点实施任何麻醉(包括,麻醉机的准备,1,、根据病人具体情况设定潮气量、每分通气,量、气道压报警上下限。,2,、选定通气模式,(,容量控制或压力控制,),，设定,潮气量或限压通气的压力限制,(,一般先为,12-,14cmH,2,O),。,3,、设定呼吸频率。,4,、设定吸：呼比。,麻醉机的准备,麻醉机的准备,5,、检查钠石灰罐和钠石灰是否变色。,6,、检查吸入麻醉药挥发罐是否有药。,7,、打开麻醉机电源，应有低氧压报警。打开中,心氧气，低氧压报警消失。,8,、检查,O,2,流量表。旋钮开至最大时，,O,2,流量 应,能大于,10L,min,。,9,、检查快冲氧是否工作。,麻醉机的准备5、检查钠石灰罐和钠石灰是否变色。,麻醉机的准备,10,、连接螺旋管和呼吸囊（螺旋管是每个病人一换）。,11,、手堵螺纹管出口，将,O,2,流量关至最小用快充,O,2,将呼吸,道压力冲至,40cmH,2,O,，此时应有连续高压报警，同,时在,15,秒内压力应仍高于,30cmH,2,O,。,12,、放开螺纹管出口，开动呼吸机，风箱上下空打，麻醉,机应有脱机报警。,13,、手堵螺纹管出口，用快充氧将呼吸囊充气，检查手控,通气是否有效。,14,、选择与病人面部相匹配的面罩，并检查面罩气垫是否,充气,。,麻醉机的准备10、连接螺旋管和呼吸囊（螺旋管是每个病人一换）,插管用具的准备,1,、检查有无简易呼吸囊、能否正常工作，镜筒、,镜片有无缺失。如有缺失及时准备。,2,、选择合适的气管导管和管芯，小儿需要多准备,大小各半号的导管一根。,3,、准备喉镜筒和大小合适的镜片，注意检查喉镜,光源亮度是否足够。,4,、连接负压吸引器和吸痰管，并注意检查负压是,否充足。,5,、准备空注射器、牙垫、胶布、听诊器。,6,、根据患者情况及上级医师意见准备其他插管用具。,插管用具的准备1、检查有无简易呼吸囊、能否正常工作，镜筒、,药品准备,1,、,常规抢救药：,肾上腺素,0.05mg/ml,，多巴胺,1mg/ml,阿托品,0.2mg/ml,，去氧肾,20ug/ml,。,2,、,麻醉药物,：咪唑,2mg/ml,，舒芬太尼,10ug/ml,，,顺阿曲,1mg/ml,，丙泊酚,20ml,。,3,、,血管活性药物,：多巴胺,Kg3,（,mg,）,/50ml,，,硝酸甘油,Kg0.3,（,mg,）,/50ml,，,去甲肾上腺素,Kg0.03,（,mg,）,/50ml,。,4,、,肝素,生理盐水（用于动脉测压导管冲洗和中心静脉导管,冲洗；血液回收所用肝素生理盐水）,抽取稀释好的药物，请贴上标签、注明浓度。小儿用药应酌情稀释。,药品准备 1、常规抢救药：肾上腺素0.05mg/ml，多巴,特殊耗材和设备的准备,双腔支气管导管、纤支镜,小儿用物：,小儿脉搏氧腕带或指套、小儿喉镜、小儿呼吸囊、小儿面罩、小儿螺纹管、小儿喉罩和气管插管、小儿吸痰管,动静脉传感器、中心静脉穿刺包、自体血耗材、医用保温毯。,特殊耗材和设备的准备双腔支气管导管、纤支镜,谢 谢,谢 谢,