3.4.2.2.1麻醉科麻醉前访视与病情评估制度[15页].pdf

封 面作者：ZHANGJIAN 仅供个人学习，勿做商业用途麻醉前访视与病情评估制度一、依据卫生部及医院病情评估制度，结合麻醉科专业特点，制定科室麻醉前访视与病情评估制度。二、麻醉前或临床诊疗前麻醉医师应亲自访视病人，同时对病人依据专业病情评估标准进行评估。我科现阶段病情评估以中华医学会麻醉学分会临床麻醉指南、中华医学会疼痛学分会疼痛诊疗技术规范、中华医学会麻醉学分会近年陆续公布的二六个临床麻醉诊疗指南和河北省麻醉质控专家委员会临床麻醉质量控制标准等专业标准或规范为基础，根据科室环境、设备、技术特点确定（详见：麻醉科病情评估技术标准）。三、麻醉病情评估应当包括麻醉前、麻醉中和麻醉后三个环节。麻醉前病情评估主要是病人合并症及其对麻醉诊疗活动医疗风险评估；麻醉中评估主要是对病情演变、麻醉诊疗操作及手术操作等对病人生理功能影响的评估；麻醉后评估主要是对麻醉诊疗效果与麻醉并发症风险的评估。四、麻醉病情评估是以病人详细病史、系统查体和相关辅助检查资料为基础，以拟行手术、麻醉治疗操作、使用设备和自身技术水平为依据，对病人诊疗过程中病情演变、相关并发症等诱发病人生理功能改变且可能造成生理功能损害的风险及后果进行预测，所有预测结果及其防范措施应当记录于病历并有效地向病人或亲属（法定代理人）说明。文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 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ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8五、鉴于麻醉科临床工作特点，从病人安全与科室协调角度考虑，麻醉科医师在病情评估中缺乏必要的辅助检查资料应首先向主管医师说明，必要时可亲自下达医嘱补充相关资料。若相关病情评估资料涉及病人安全应暂缓手术或诊疗操作，待评估资料齐全后方可进行手术麻醉或诊疗。六、手术麻醉病人麻醉前病情评估以ASA 病情评估为标准，ASA 级及其以上者应当按要求适时向上级医师汇报；科主任根据汇报情况，经与相关专业科室科主任沟通协商，确定麻醉前病历讨论或呈报医务部。涉及公检法、新技术工程、临床教案和特殊危重手术或诊疗病人病情评估结果应当由科主任审核，必要时上报医务部和主管院长审核。七、麻醉诊疗病人（包括无痛诊疗、危重病抢救和中心静脉置管术等）在实施诊疗操作前应当认真阅读主管医师完成病历资料，有效追述麻醉相关病史并重点查体；门诊患者则应当亲自病史询问与查体，完善相关辅助检查后有效评估患者心肺功能，尤其是患者对麻醉诊疗耐受水平。高风险麻醉诊疗应当请示上级医院并有效与患者及亲属、相关诊疗医师沟通协调，有效降低麻醉诊疗的风险。八、所有手术麻醉与麻醉诊疗方案与实施均应以病情评估结果为基础确定，麻醉与诊疗方案须包括评估风险防治措施、应急处理流程与病情知情同意等内容。极高风险患者麻醉与诊疗须经科室讨论且由二名以麻醉医师共同负责实施。九、任何人、任何时间与任何麻醉或诊疗活动均应确保病人病情进文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 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ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8行有效评估，科室质控小组成员依据相关考核规定对病情评估进行动态考核，考核结果纳入个人绩效考核，违规操作与麻醉管理导致病人损害麻醉医师个人按规定承担相关地处罚。十、麻醉医师应当针对日常病人病情评估中出现的新问题不断提出完善措施，经科室质控小组讨论并由科主任呈报职能部门审批，定期修定麻醉及诊疗病人病情评估标准，以最大限度地维护病人安全。手术与麻醉诊疗前病情评估标准作为一名麻醉医生，首要职责就是保证手术病人的生命安全，同时也应为手术的顺利开展提供必要的条件，为病人的尽快尽可能的功能康复提供高质量的心理及生理保护。安全的麻醉始于手术前，全面的麻醉前评估和准备工作能极大地化解手术麻醉风险。通过全面的评估可以发现一些影响治疗效果的未知病情，这样麻醉医生就能预见到问题所在，并制定出相应计划来最大限度地减小所带来的负面影响。另外，术前评估给予医生信心和处理突发事件的心理准备，亦使患者充分相信医疗保障系统对自己健康所做的努力。【麻醉前评估的最终目标】最大限度降低围手术期并发症的发生率和病死率。并尽可能地降低围术期费用。【麻醉前评估的手段】阅读病历，体检病人、与病人交流获取相关病史，最终达到掌握病情的目的。【麻醉前评估的内容】一.获得有关病史、体格检查、实验室检查、特殊检查和病人精神状态的资料以及拟行手术的情况，进行分析和判断，以完善术前文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8准备并制定合适的麻醉方案。必要时就麻醉和手术的风险与手术医师、病人取得共识。二.指导病人配合麻醉，回答有关问题，解除病人的焦虑和恐惧。告知患者有关麻醉、围手术期治疗以及疼痛处理的事项，以减轻患者的焦虑和促进恢复。【麻醉前评估的时间】平诊手术：术前一日；急诊手术：麻醉前。【麻醉前的评估的重点】循环功能(含血容量与血红蛋白)及呼吸功能(含呼吸道通畅与否)，凝血功能和肝肾功能。【麻醉前评估的结果】一.根据病人的具体情况，确定病人是否处于合适的手术时机(何时手术、禁食起始时间)；二.在无必要进行其它检查和治疗，术前医嘱是否符合麻醉要求；三.填写术前访视单，并制定麻醉及围术期处理方案(如有无特殊麻醉监测设备功辅助治疗，例如：自体输血，备血量，备特殊血液用品如血小板、凝血因子等，手术后有无特殊监护需要，有无转入ICU 必要，有无术后进行机械辅助通气需要、有无术后镇痛需要等)；四.进行麻醉前谈话，病人和(或)病人的委托人在麻醉知情同意书上签字以示对麻醉风险知情同意。【病史询问】一.详细询问及查阅住院病史记录，分析原发病的发生、发展及其严重程度，以及可能的诊断、治疗方法及治疗反应，应特别注意生命体征的变化趋势和液体平衡状态。二.了解病人精神状态，发育情况，有无贫血、脱水、紫绀、发热、过度肥胖。近期内的体重变化。小儿麻醉必须常规称体重。了解病人日常活动情况，包括最大活动量。三.仔细检查和查阅体检记录，注意血压、脉搏、体温、呼吸、血、尿、粪、出凝血时间等常规检查结果。以及全面检查了解心、肺、肝、肾、脑等生命器官的功能状况。特殊病人应注意上下肢血压的差异。四.检查中发现有明显异常或并存内科疾病时，常需进一步作有关的实验检查或特殊功能检查，必要时同有关医生商讨进一步术前准备的措施。五.询问病史时以“器官系统”为主线，重在疾病的症状、体征、治疗的近期变化，对不熟悉的实验室检查结果、治疗用药等应文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8积极寻求专科医生的帮助，应明确治疗现患病症及并存疾病所用药物种类、剂量，抗高血压药、抗心律失常药、抗心绞痛药、抗凝药、抗糖尿病用药如胰岛素以及抗痉挛药是重点，应对是否继续使用、停药的潜在反应、与麻醉药的相互作用等问题做出思考与决定。六.了解个人史，过去史、以往手术麻醉史及治疗用药史：（一）个人史应注意是否吸烟、吸烟时程及量；有无嗜酒及使用安眠药等，鼓励病人术前二四周减少吸烟，术前一周戒烟，以降低气道高反应性和围术期肺部并发症；嗜酒者因戒断酒精会诱发严重高血压、震颤、谵妄和抽搐，并明显增加麻醉药用量；滥用兴奋药者可能导致心悸、心绞痛、消瘦和降低心律失常和惊厥的发作阈值。（二）围麻醉期用药所致的意外异常不良反应较为多见，应注意区别是变态反应还是药物反应。真正的变态反应病史中有皮肤征象如皮肤发红、发痒、荨麻疹，面部或口腔肿胀，呼吸短促、窒息、喘鸣，低血压血管虚脱等，应进一步寻找可能的变态反应源。（三）对有麻醉史的病人应重在了解：对镇静、镇痛及麻醉药物的敏感性；有无气管插管困难病史；围术期有无麻醉不良反应如术中觉醒、牙损伤、术后严重恶心、呕吐、术后心梗或心衰、术后苏醒延长或ICU 停留时间等。七.在病史询问及病历的阅读中，应特别注意：（一）诊断是否明确；（二）手术的部位、方式、时间长短及是否有特殊要求；（三）有无异常的手术麻醉史、家族史；（四）特别注意病人的特殊状态：如妊娠、月经期、精神抑郁或焦虑等；（五）有无遗漏的重要病史及并存疾病(如急性呼吸道感染、哮喘、糖尿病、甲亢、冠心病、青光眼、癫痫等)。在术前评估中麻醉医生应该认识到：能适应日常生活的患者状况并不一定就是能满足手术的最佳状况。例如一定程度的肾前性氮质血症伴充血性心力衰竭的术前患者仍能适应日常生活，但是手术麻醉时血管扩张可能引起低血压或永久性肾损害。应仔细评估围手术期操作对此类患者生理的影响。【体格检查】麻醉医师对病人的体检应全面，但要突出重点。应重在判断围麻醉期保持呼吸道通畅的困难程度，心、肺、脑的功能，脊柱、四肢状况等。一、一般状况文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8测血压，对疑有大动脉病变病人应测上下肢血压，了解其压差；测脉搏的节律及频率及饱满度；测呼吸的节律及频率及呼吸方式；了解体重与身高，计算体重指数(BMI)，以指导用药量及输液量，BMI(kg/m2)体 重(kg)/身 高(m2)，正 常 男 性 的 为22 kg/m2，女性为20 kg/m2，BMI 25 29 为超重，BMI 30 kg/m2为肥胖，若体重超过标准体重的100%，为病态肥胖。小儿标准体重及参考计算公式见表一-一。表一-一 正常儿童体重及估计公式年龄或月龄体重(kg)初生婴儿3.30.4(男)；3.2.0.4(女)1 个月初 生 婴 儿 体 重+1.0 1.5 3 个月初生婴儿体重2 312 个月(月龄+9)/2 16 岁年龄2+8 712 岁(年龄7)-5/2 二、颈部：头颈部的检查的目的在于评估气管插管的难易程度及围麻醉期保持呼吸道通畅的困难程度。应从张口大小(应大于 2 横指)、头颈活动度(能自行将下颌触及胸部，能向后伸展，侧向旋转无疼痛或感觉异常)、甲骸距离(颈部完全伸展时，从下骸突至甲状切迹的距离，应大于34 横指)，喉部的活动度，有无甲状腺包块、气管有无移位等方面评估。具体评估方法见第四章气道管理技术。三、心、肺：心前区有无异常隆起，心界大小、心脏听诊有无杂音、奔马律、心包磨擦音，呼吸通畅与否，有无辅助呼吸肌参与呼吸，听诊有无哮鸣音、干湿啰音及范围。四、腹部：腹胀程度、腹压大小、有无腹水，包块，腹壁静脉曲张。五、脊柱四肢：脊柱有无畸形、感染，四肢肌肉有无萎缩、杵状指、紫绀及皮肤感染等。六、神经系统：意识状态、颅神经功能、认知能力及周围感觉运动功能。【实验室检查】实验室检查工程依病人年龄、所患病症、拟行手术而有所不同。一、常规化验检查我国目前通用的观点为：择期手术术前一般应检查近期(一般为文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q8文档编码:CQ1I4H2N3H3 HC1S5W9S8M9 ZO8F3R7H9Q