七氟醚吸入麻醉临床应用(实用课件).ppt

七氟醚吸入麻醉临床应用(实用课件)23七氟醚的发展历史 1968-七氟醚首次合成 1975-完成动物试验 1981-完成人体试验 1990-首先在日本上市 1995-在欧洲和美国上市 2005-在中国上市4七氟烷 Sevoflurane,七氟醚, 药理作用 MAC为1.71%，血气分配系数为0.63，诱导快、苏醒快组织溶解性较低，在体内的代谢程度相应也低； 对循环抑制轻，不增加心肌对儿茶酚胺的敏感性，不易引起心律失常； 麻醉时不增加脑血流量，颅内压增加不明显，脑耗氧量下降有一定的肌松作用，可强化肌松剂的肌松作用； 对呼吸道刺激低，可松弛气管平滑肌，能用于哮喘病人5七氟烷的临床特点 一、 七氟烷的MAC恒定 二、起效快、消除迅速 三、对脑血管的自主调节无明显抑制 四、心血管系统稳定性良好 五、对呼吸功能影响小66个月内的小儿MAC几乎没变化.因此七氟烷导致麻醉药物过量的几率很低 (相比氟烷,新生儿MAC要小) Anesthesiology 1994 ; 80:814-824Lerman J, et al.一、七氟烷的MAC恒定 7Sevoflurane Minimum Alveolar Concentration (MAC) by AgeData on file, Abbott Laboratories Inc.Data on file, Abbott Laboratories Inc.AgeAgeMACMAC in O in O2 2 (%) (%)MAC inMAC in65% N65% N2 2O/35% OO/35% O2 2 (%) (%)0 - 1 mo*0 - 1 mo*3.33.3- -1 - 6 mo1 - 6 mo3.03.0- -6 mo - 3 yr6 mo - 3 yr2.82.82.02.0 3 - 12 yr3 - 12 yr2.52.5- -25 yr25 yr2.62.61.41.440 yr40 yr2.12.11.11.160 yr60 yr1.71.70.90.980 yr80 yr1.41.40.70.7* *Neonates are full-term gestational age. MAC in premature Neonates are full-term gestational age. MAC in premature infants has not been determinedinfants has not been determined 60% N60% N2 2O/40% OO/40% O2 2 was used in patients aged 1 - 3 years was used in patients aged 1 - 3 years8二、起效快、消除迅速 健康志愿者用23七氟烷，在第五次呼吸时就丧失知觉 4七氟烷患者2分钟意识消失9N2ODesfluraneIsofluranesofluraneHalothaneHalothane10.80.60.40.200 010102030Minutes of AdministrationFA/FISevofluraneInspired & Alveolar Concentrations (FA/FI) of various AnestheticsYasuda et al. Anesth Yasuda et al. Anesth Analg. 1991.Analg. 1991.8七氟醚和地氟醚因较低的溶解度达到快速 WASH-IN101 10.10.10.010.01F FA A/F/FA0A00102030405060minisofluranesevofluranedesfluranedesflurane(10)(10)(1.25)(1.25)(1.02)(1.02)Elimination Kinetics FA/FAO of Inhaled AnestheticsRatio of the Alveolar fraction (Fa):Alveolar fraction at the moment when the Ratio of the Alveolar fraction (Fa):Alveolar fraction at the moment when the vaporizer is switched off (Fa0)vaporizer is switched off (Fa0)8七氟醚和地氟醚因较低的溶解度达到快速 WASH-OUT11Recovery Profile:Recovery Profile:Sevoflurane vs IsofluraneSevoflurane vs Isoflurane* p* p0.05 vs isoflurane 0.05 vs isoflurane Philip et al. Anesth Analg 1996;83:314.Philip et al. Anesth Analg 1996;83:314.Sevoflurane (n=149)Sevoflurane (n=149)Isoflurane (n=97)Isoflurane (n=97)Response toResponse toCommandCommand* *Eye OpeningEye OpeningMean Time (minMean Time (min) )1212* * *OrientationOrientation10108 86 64 42 20 0 Aldrete scores Aldrete scores Recovery score 8: 95% of Recovery score 8: 95% of sevoflurane patients vs 81% of sevoflurane patients vs 81% of isoflurane patients (isoflurane patients (p p=0.004)=0.004)More rapid recovery of activity More rapid recovery of activity ( (p p=0.001)=0.001)More rapid recovery of More rapid recovery of consciousness consciousness ( (p p=0.003)=0.003)12Recovery With Desflurane vs Sevoflurane: Effect of Anesthetic Duration0204024682468Time to OrientationTime to Response to CommandHours of AnesthesiaMinutes After1.25 MACAnesthesiaDesfluraneSevofluraneSevofluraneDesfluraneEger et al. Anesth Analg. 1998;86:414.11 mins18 mins13 mins21 mins13Sevoflurane Recovery Profile:Sevoflurane Recovery Profile:Better than Propofol (Outpatient Surgery)Better than Propofol (Outpatient Surgery)* p* p0.05 vs propofol 0.05 vs propofol Dubin et al. Anesthesiology 1994;81:A3.Dubin et al. Anesthesiology 1994;81:A3.* * * Response to CommandsResponse to CommandsEmergenceEmergenceMean Time (min)Mean Time (min)SevofluraneSevoflurane(n=143)(n=143)PropofolPropofol(n=143)(n=143)121210108 86 64 42 20 014Sevoflurane Recovery Profile: Better than Propofol (Inpatient Surgery)Mean Time Mean Time (min)(min)Jellish et al. Anesth Analg 1996;82:479.Jellish et al. Anesth Analg 1996;82:479.0 02 24 46 68 81 10 01 12 21 14 41 16 61 18 82 20 0ExtubationExtubation O Or ri ie en nt ta at ti io on nSevoflurane (n=93)Sevoflurane (n=93)Propofol (n=93)Propofol (n=93)Response toResponse toCommandsCommands15陈绍辉黄宇光黄一宁地氟醚、异氟醚和七氟醚对脑血流速率的影响临床麻醉学杂志2001 年3 月第17 卷第3 期J Clin Anesthesiol ,March 2001 ,Vol. 17 ,No. 3三、对脑血管的自主调节无明显抑制大脑中动脉的平均血流速度(mean velocity ,Vm)；平均动脉压MAP；心率HR16 七氟醚对心排出量无明显抑制作用 对冠状血管的作用较弱 较高浓度吸入时可引起血压下降,其下降原因主要是由于降低全身血管阻力所致。

四、心血管系统稳定性良好1760608080100100120120Heart Rate (beats/min)Heart Rate (beats/min)Base-Base-lineline1 1 5 5 3-5 3-5 1-3 1-3 151560 60 5 5 3030Time (min)Time (min)EmergenceEmergencePost-Post-intubationintubationPre-Pre-incisionincisionPost-Post-incisionincisionPrior Prior to End ofto End ofAnesthesiaAnesthesiaPost-Post-emergenceemergence* * * *Heart Rate Response to Sevoflurane and Isoflurane: Elective Heart Rate Response to Sevoflurane and Isoflurane: Elective Surgical CasesSurgical Cases* * p p0.05 vs isoflurane0.05 vs isofluraneEbert et al. Anesth Analg 1995;81:S11Ebert et al. Anesth Analg 1995;81:S11. .* *Sevoflurane (n=50)Sevoflurane (n=50)Isoflurane (n=25)Isoflurane (n=25)18Hemodynamics during inductionSevoflurane vs Propofol5065809511012512345Time (minutes)MAP (mmHg)SevofluranePropofoln=102Age 1885 yearsThwaites et al. Br J Anaesth 1997;78:356.Thwaites et al. Br J Anaesth 1997;78:356.1990908080707060605050Mean Art。