Tall danger patient accompanies the medical disease that has different rate more, in medicine clinical in the center be called " patient of risk surgical department " , as the ceaseless development of level of medical treatment technology, clinical go up grow in quantity of crowd of tall danger patient. Current, the rate causing damage that surrounds operation period and rate of die in one's bed basically still are centered in tall danger patient. Director of division of anaesthesia of the 3rd hospital Professor Guo Xiangyang says Beijing University, anaesthetic doctor is in clinical in the center how to identify anaesthetic Gao Wei's patient, alternative in time on choice of the what kind of anaesthetic means that monitor, medicaments how the consider, happening that how prevents POCD of Gao Wei's patient, these are the crucial questions that anaesthetic doctor needs to master.
Inchoate identifying patient of Gao Wei anaesthesia conduces to operation plan making
Anaesthetic doctor is in clinical in the center general from the following 3 respects will identify anaesthetic Gao Wei's patient: (1) the complex degree of the operation; (2) surgical patient companion has complex medical disease, if function of hypertensive, heart disease, heart is not congruent; (3) the difficult easy degree of anaesthetic operation. Association of American anaesthetic doctor (ASA) it is dangerous to the operation that at the basis before anaesthesia patient constitution state is mixed the gender undertakes classified, it is patient cent 6 class in all, the patient that reachs 3 class above is defined for patient of tall danger difficulty.
The anaesthesia of tall danger patient is monitored, the special situation of the patient when need combines operation difficulty and anaesthesia to carry out changes and make individual the plan that change. "The operation treats a disease, anaesthesia maintains an order; Have small operation only, drunk without Xiaoma. " Guo Jiao awards respecting, during the operation, anaesthetic doctor needs style of whole to the patient life to ask for accomplish essence of life to refine management, ensure anaesthetic security and effectiveness. General and average patient, anaesthetic doctor can carry out anaesthesia according to a collective principle. "The anaesthesia of tall danger patient is the challenge of pair of anaesthetic family doctors! " Guo Jiao awards the introduction, as a result of the patient of amalgamative systematization disease before art, especially senile patient, surround art period serious complication is more, ability of acting countervail of function of main internal organs of the body is poor, height of need anaesthesia doctor centers what attention makes very anaesthetic plan to make and monitor in art, the management after art.
(The picture comes from graph bug originality)
Program of blood pressure monitoring is individual change
Doing patient of very tall danger to surround the blood pressure monitoring of art period is a very crucial question. Because of us perfusion of human body heart needs to rely on blood pressure to satisfy, because this is controlled to surrounding the blood pressure of art period, anaesthetic doctor can is worth according to the normal blood pressure of international standard, according to the patient particular case (because human body is put in individual difference, the blood pressure of some people can have dynamic change 24 hours) will make operation plan, control is hypertensive, prevent low blood pressure, maintain appropriate blood pressure and heartbeat, assure the perfusion of the main internal organs of the body such as patient brain, heart, kidney.
(The picture comes from graph bug originality)
The palm of special processing means and anaesthetic deepness charges patient of tall danger anaesthesia
Amalgamative hypertension is mixed before senile, art the show that the hemal disease, patient that has accepted operation of department of heart surgery, neck and operation of old blood vessel can have blood pressure to fluctuate, art hind is incidental hypertensive. Anaesthetic doctor is met according to patient condition, the patient lets choose appropriate step-down remedy to take before art, effective control is hypertensive. The patient of depressor is taken before art, to medicaments take should maintain an operation that day in the morning. Among the operation, anaesthetic doctor basis blood pressure circumstance, want to adjust the anaesthetic pattern of pitch on to the patient not only, still must notice anaesthetic deepness, the harm sexual excitement that assures surgical operation can match with anaesthetic deepness photograph, and control blood pressure be in reasonable range.
Medicaments choice, good analgesia all is the significant step of POCD of prevention and cure
Obstacle of function of the acknowledge after art (POCD) it is the complication of common central nervous system after the operation is anaesthetic, the age is his relevant element, especially the occurence rate of senile patient is general taller, to clinical anaesthesia the doctor brought major challenge. Inchoate and senile patient can appear after art the delirium after art, appear after the operation is anaesthetic attention drops and acknowledge is disorder, its incidence of a disease is 5.1%-52.2% ; Art hind is terminal, namely a month after art, some patients appear slow, slight, abiding memory, cognitive function, executive function drops, its incidence of a disease is 30%-40% . Our country combines international to go up to consider to make clear for years, the happening of the POCD after bringing about art is not pure the reason that is anaesthesia, still include patient factor (circumstance of the age, physiology and amalgamative disease) , the reason such as operation means and the processing that surround art period, anaesthesia management. "The mainest the operation scar that gets with the patient is concerned, operation scar let the severe reaction of patient whole body cause cerebrum to also produce severe reaction, this is the process that brings about POCD happening finally " Guo Jiao awards respecting. POCD caused international to go up to pay close attention to extensively to the influence of working ability. International considers to show, POCD is after art the near future 6 months less than is tall hair period, 6 months after art can alleviate gradually later, but as congenital as individual patient also element is having inseparable concern, if exercise little, fight blow ability is weaker etc, cause this kind of patient to be able to appear POCD.
Professor Guo emphasizes, "How does anaesthetic doctor choose dope to coordinate surgical operation, reduce surgical operation to harm the sexual excitement influence to patient brain? This is us anaesthetic doctor is in clinical on the way that needs ceaseless exploration. " before art, anaesthetic doctor and the deciding that the surgeon begins time to the operation should have been done specific communicate. Pair of anaesthetic deepness and cerebral oxygen degree of saturation strengthen in art monitor, stupefy medicaments and photograph of operation scar degree match, reduce the dope effect to cerebrum, reduce the incidence of a disease of senile patient POCD.
Additional, the good analgesia after art is very important also. The patient can have cut, where a thing can be put to best use later in the operation, if of travel is celiac operation, celiac within still has achieve a face invisibly. The ache after the metropolis below this kind of circumstance causes art and unwell, these harm sexual excitement stimulate central nervous system can continually, cause an effect to the cognitive function after patient art. Art hind has a lot of demulcent methods now, for example hard outside anaesthesia of organization of demulcent, area, vein is demulcent, still have blame carrier a few fight phlogistic drug, the analgesia that passes these much mode will reduce the effect that causes to the patient sorely, be opposite especially the influence of cerebral function.
Anyhow, anaesthesia of tall danger patient is put in particular risk, be aimed at patient of tall danger operation, doctor of need anaesthesia family is surrounding art period train of thought of the innovation on clinical management method. Inchoate identifying tall danger patient conduces to an operation decision-making, the essence before art allows to evaluate, optimize plan, art has the monitoring government of specific aim after medium, art, take active and significant step to the complication that may produce during anaesthesia, improve patient prognosis.
[expert brief introduction]
Guo Xiangyang, m.d. , professor, doctoral student adviser. Currently hold the post ofBeijing University director of division of anaesthesia of the 3rd hospital. Hold China anesthesiology part-time to meet a standing member, standing member of branch of doctor of anaesthesia of Chinese doctor association, beijing medicine meets committee member of vice director of anaesthetic and professional council, anesthesiology of ministry of Beijing University medicine fastens a director, ministry of Public Health is advanced the title evaluates an expert, china medicine meets expert of library of popular science talent. Its basically study direction includes: 1. Narcotic manages; 2. Surround the base that main internal organs of the body protects art period and clinical research to wait. Publish a paper in all in periodical of domestic and international learning 92 (SCI collects 21) , attend write book 8.
Manage national science fund at present 1, course of doctor of colleges and universities chooses fund of special scientific research 1, beijing University the 3rd hospital is clinical priority discipline 1, beilangke learns fund 3. Foundation of science of the country that finish 2, in addition still include a country to teach appoint, foundation of fund of key of human affairs ministry, Yang Sen science and Beijing assist aid financially a task with fund of hospital scientific research in all 6. Ceng Rong is obtained annual meeting of surgical anaesthesia of British bosom heart and vessels is outstanding 2000 paper award, beijing anesthesiology can reach countrywide anaesthesia to learn excellent paper award 6, attend " the clinical application that analgesia accuses oneself after patient art studies " have the honor to win award of China medicine third class and progress of science and technology of institution of higher learing second-class award, have the honor to win Beijing assist with award of achievement of hospital medical treatment 11, beijing University medical treatment of the 3rd hospital is outstanding award 6.
