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第四节 全身麻醉患者的护理
全身麻醉是目前临床上最常用的麻醉方法。全麻患者表现为神志消失,全身的痛觉丧失、遗忘、反射抑制和一定程度的肌肉松弛。全身麻醉能满足全身各部位手术需要,较之局部和椎管阻滞麻醉,患者更舒适、安全。
一、护理评估
1.麻醉前和麻醉中评估
(1)健康史
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00039002.jpg?sign=1739252130-qJPKAmegC5ZfS38eGopN5GVYJiSv41KL-0-5fcd2beab6a8567b4a7cdf73ec21b8af)
(2)身体状况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00039003.jpg?sign=1739252130-n608Ligv1LWJSOZavBIqccA9Gv3MtmQE-0-e5f56584480dd07e4bc7f8ad381fb33b)
(3)心理-社会因素
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040001.jpg?sign=1739252130-PIrovrfWbmZ0waCUstJUBafmjepUXOgf-0-6191e29bb664aa2c8a4d85b7cdfac526)
2.麻醉后评估
(1)术中情况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040002.jpg?sign=1739252130-gF80k5izitolwjKNPTwowWgh8Aoh82wK-0-c6ed1248636be4e257b911daa26b8d3e)
(2)术后情况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040003.jpg?sign=1739252130-p1PIzWVLe0tT1eDZNB0nDv1FWLbih92a-0-1ce844dd8a9175b926239bb90199c095)
二、护理诊断
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040004.jpg?sign=1739252130-AwdovMSzSG7dqAW8sDgyDaTNDAMsu40K-0-b7fef9097136b30a47c63ed0b48602cd)
三、护理措施
1.麻醉前护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040005.jpg?sign=1739252130-MxX4wOaUvVUw4Wl5CvEauVpWTwG8b0yZ-0-3912368563b4b4e27f7512ddb4833342)
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00041001.jpg?sign=1739252130-Uc0wwYOc8MFYpKLjrPpsj7FERNKVFJEu-0-38698301c49fca928519ea0198d754b6)
2.麻醉恢复期的护理
(1)全麻恢复期的护理常规
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00041002.jpg?sign=1739252130-HFHwE7JPx63in0wOQos41veZ68Q4EtHC-0-e511e0d5f74657809b31678247a1d7b3)
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042001.jpg?sign=1739252130-0tJeDLLkHZtmdWKcSqJFO82JoLYY0Ovk-0-94046d9d5529d05af6579c02830a1dd5)
(2)恢复期评分标准:可采用Aldrete护理评分方法,具体标准如表3-3所示。
表3-3 Aldrete护理评分法
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042002.jpg?sign=1739252130-1TbzpCbtbgDMHYsoYFEvjr5DTNrbmSmM-0-8dd3a79ce0ace16a3f1e2004c9a84886)
(3)拔管指征
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042003.jpg?sign=1739252130-iMviZCeRBwGlnM5Mn2KU3n2yg9J7kZ6P-0-e02ea4f1d668948e6ab7cb1629a0671c)
(4)麻醉恢复期常见并发症及处理
①呼吸道并发症处理:呼吸系统并发症发生率为1.7%,主要以低氧血症为主,与患者的年龄、性别、体重、吸烟嗜好和麻醉药物的残余作用等诸多因素有关。
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00043001.jpg?sign=1739252130-4PQcLvXbNvflS4xIEmRdAbUE5PZju0J0-0-3bf02d64b77e227eef9c23a7d8c726f4)
②循环系统并发症的处理
a.低血压的处理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00043002.jpg?sign=1739252130-BkFiDV7BC6ETNqN2LdAIojSMD4yHFbJn-0-dcd03132f14d054947125a86c2a0a42a)
b.高血压的处理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00043003.jpg?sign=1739252130-Sm5u8gtEp7ESmPFO34uhmrLM0RX5rLoR-0-fee24dcc72e981827298b352faf5ee02)
c.心率异常和心律失常的处理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044001.jpg?sign=1739252130-HqlZRg3slaRCU9dazmapSfdrtnxjMr5l-0-287840c937434fef364643217fc9ecd4)
③消化系统并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044002.jpg?sign=1739252130-33Z7nj7cXjO1ffVRTBuMcMyhkwcLYiOy-0-eab568646cf2fbc3cec6cf8d63f48986)
④神经系统并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044003.jpg?sign=1739252130-3FzVsoXiGIL9fEy4swTVMNM2l3DtXnp3-0-2c65dc2923dc5ca51f7d36c9baeec9ee)
⑤其他并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044004.jpg?sign=1739252130-uZ8T9QzZ1GzqzwIrOSQTa8TqQ5KbpVzd-0-2f88caf27ffdea7eecf504aeb6c5d4db)
四、健康教育
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044005.jpg?sign=1739252130-e0juO25PYCTuxUqowEcfjZuPN9P6ANRr-0-c1352387c7dc534c9b46d71412caa5e3)