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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=1739490520-uFquxgfdf6r0NBBijWNCQgcKbeqsCey2-0-ece6d9b7e679f59cd666151638fd2b22)
(2)身体状况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00039003.jpg?sign=1739490520-ksMvvnOCnBXK7SZZ3KAAEa36haW04Hwp-0-39af367fd5b870beb985ffdff33ba3bb)
(3)心理-社会因素
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040001.jpg?sign=1739490520-lf3y4OIgWEYahqSQrcUVXlT0DBc57Egh-0-e05cd76113b0ddac505130446e39eaf7)
2.麻醉后评估
(1)术中情况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040002.jpg?sign=1739490520-qT9hCoOX4QAqzZexacKqbbYqePRcArBB-0-d0907a0cb71db62ecf358df7432ef4c2)
(2)术后情况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040003.jpg?sign=1739490520-Lx3ySNpB96alPQAWYnnaR7DHRfEndyAf-0-97e8f6e47a1b7acd290b2dfb019cd313)
二、护理诊断
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040004.jpg?sign=1739490520-bQ3vM6listoirUzIRlSwXG0HpSRM9KIa-0-51892a908491e3568aed8006aa5a63dd)
三、护理措施
1.麻醉前护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040005.jpg?sign=1739490520-7Ybnpq4VglQvWcs8K9oMrt5lS7txrYtV-0-936709ae1f99224f21600a8fe05b61d9)
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00041001.jpg?sign=1739490520-H3FwjR1SCeLU5746zQbZKmrayzTh574O-0-f0dbedea382a116a64952759d3a038e5)
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=1739490520-m13UnVz8M8ody8Rs9oqJ4FKkpe6KLFBN-0-7b96a764cfd7558706d71ca6eac16d47)
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042001.jpg?sign=1739490520-PR5G8PoXNjmEdx0eFmE0TikUiGUTDzUW-0-7b0cb17f772f150a344808212e70162a)
(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=1739490520-dkCDcaKFstUgQJtIXMeW3vfGNUGsfRDs-0-e6ade4047a82ded0bae3c7a6402def8a)
(3)拔管指征
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042003.jpg?sign=1739490520-XnTlJis1NSMt0uNxlmFLXh5vkr2oOeJI-0-ffbc9b379a70f4e31b99578a73c4fd6e)
(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=1739490520-XYfGsUfohdfff1vRdnGfyKWOKd9ukmq4-0-3eaac9098941bef24123951d7d5730e0)
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=1739490520-jasOTt7GuIBAFF9Vwhy3km5IjFIzw5YQ-0-82a67c879517def2e05a1708840bbe66)
b.高血压的处理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00043003.jpg?sign=1739490520-8XvMrRLCaOBWtDSuMH0KuP9kX5NUQpYZ-0-1550b7c8a6c8b0975d1292d34d32ad98)
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=1739490520-PJTLJDFzWdT8613v3upEEtpH6GIiSf9G-0-e4c323725e47bd475ee0e81fde16671e)
③消化系统并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044002.jpg?sign=1739490520-eYjf9FM9DoaIdkFLFfshiyRjRwbvCyCe-0-4e026c6088178de9f66d547ff9ec1bce)
④神经系统并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044003.jpg?sign=1739490520-K7vQn56NIQo9y8rKP1jQn7vgxBE84NjN-0-d689da06f866e94da691764b02ef6f35)
⑤其他并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044004.jpg?sign=1739490520-zU5U5SWTfNjG8eISosKNZWstiLnFs2Ru-0-400071c27b9639c2309aa761d94a035d)
四、健康教育
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044005.jpg?sign=1739490520-1L0bWBSgt46puqwXaQac1yNWxGaITkBB-0-760b7b7f6393b3153e6c5bd4a177bbad)