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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=1738788133-xUfgHP4Elngv0z96qNMkbVbITzR4VyWR-0-e39cce502ca79947b5242eb8f0ffa8f0)
(2)身体状况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00039003.jpg?sign=1738788133-IKLkBjaw13WlA8Lk4xmbace6ylOUVH3C-0-458efd172b46d201cfe550ef77ccfe21)
(3)心理-社会因素
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040001.jpg?sign=1738788133-86xrdR46GOUjEoXWu8aqHPI1QSVQt1sc-0-14dbecc3acc63b702380276598537f65)
2.麻醉后评估
(1)术中情况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040002.jpg?sign=1738788133-814fMo7PoMd5bcZ2RaDwofYWb6pFoZHf-0-9786f9c3e3099999ec35ccb31db7cf30)
(2)术后情况
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040003.jpg?sign=1738788133-UEzlAkGYmhA1sHg3CBqfuoXIazvt1nAP-0-78418e1baefcd828146351431c2d26c4)
二、护理诊断
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040004.jpg?sign=1738788133-DLvmwhw5GOy5fasJrQENLlvI0ehft5kN-0-93d47488016b07c01b8d4f23c244608f)
三、护理措施
1.麻醉前护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00040005.jpg?sign=1738788133-6usWpn4QX8BVj79VUd30iMR4Gs704gO8-0-acd5ecddb7ef12b0eb8271b9659fc2cf)
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00041001.jpg?sign=1738788133-Ri8lvzK2MABW4jlOmxcQjldGveuDObsm-0-7422f31813463bf359c1d65b3276a9e3)
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=1738788133-ig1cUgcwgwN6CSiRt8VwmeZAnwHDXrOm-0-38c91b4f88dace06335eeb273e3620fc)
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042001.jpg?sign=1738788133-j98SKBmzSfAmLHxURmpt2sqSJtTWrA2B-0-272c05096920a5e7afd03c7ce19884e3)
(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=1738788133-m4PTqNhmw0X31Hf7eCVMwCcHX0wWjZNN-0-bf4f9d54925a929c518bb4822111419c)
(3)拔管指征
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00042003.jpg?sign=1738788133-5p1jPuZLu6nmqrGzuUA9IicojEvV1DGp-0-4b93c033bcae0bc23ebaab4eca2e30dd)
(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=1738788133-diy48xpCAUJqMKtIsqKXNPOu0KCJzxVn-0-752048d4555c3e987ac1f610f93fc955)
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=1738788133-cDwtSB3TrwzFQ4KvyzmpRdc0eQme6A1M-0-405bd74581cad9e4a40b2aa4d4b83c6b)
b.高血压的处理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00043003.jpg?sign=1738788133-SnJNedsZy6I8ysAmYZySLEPJ363ma67c-0-7746a0da7bd2de3182c388e03e589f46)
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=1738788133-owNoVKtQsOV5ZNgPyrtVFecdflekfve3-0-2e2211b94eae8b97e3442537fee92ca2)
③消化系统并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044002.jpg?sign=1738788133-CZgJcppAhkr82GZIOlYCPxefo4H9x6k7-0-95f83cf9dced061d715513cb1619f49e)
④神经系统并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044003.jpg?sign=1738788133-TH2tEbJoab3GpubLgwLE6QgkbkuXngmh-0-b3f195fc2f0838d26a3863b0ececaf69)
⑤其他并发症的护理
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044004.jpg?sign=1738788133-ym30AT1RjPN4EazxeJ2DLCMaZ49byKF8-0-a02e867dee2f8cf0b30540522225911d)
四、健康教育
![](https://epubservercos.yuewen.com/4A9E5E/16499767105832106/epubprivate/OEBPS/Images/img00044005.jpg?sign=1738788133-zVZeRyeZhPTkBrXRmdukGPI5cokU57iR-0-99174de53ec31c8ab867310b92de6571)