四川大学华西临床医学院 麻醉学 教学大纲 （适用专业：临床医学八年制 ....doc

四川大学华西临床医学院麻醉学教学大纲（适用专业：临床医学八年制）麻醉与危重病教研室/(教研组)修订日期： 2011 年 6 月目 录1.课程介绍32.绪论和麻醉前准备53.全身麻醉54.输血与血液保护 75.神经阻滞麻醉和椎管内阻滞麻醉86.气道控制97.呼吸功能的监控 108.血流动力学监控 119.体外循环 1210.氧供需平衡1311.休克1412.体液酸碱平衡的监控1513.外科营养1614. 急性肺损伤（ali）和急性呼吸窘迫综合征（ards） 1715. 多器官功能障碍综合征1816. 心肺脑复苏1917. 疼痛学21“麻醉学”课程介绍一、 课程基本信息课程名称：麻醉学英文名：anesthesiology课程号：502116020课程类别：专业与服务课程群必修课学时：48（讲32，习16） 学分：二、 教学团队教学单位负责人：罗朝志 教授，tele-mail：课程秘书：梁鹏 医师，tele-mail：liangpeng_三、 课程教学目的认知教学目标：掌握麻醉学领域相关理论知识、临床常用监测意义等，熟悉目前常用麻醉技术，麻醉前评估。技能教学目标：掌握临床常用监测运用，cpr等技术，熟悉气管插管指征、操作流程等。职业素养教学目标：培养合格、较全面的临床医师。四、 临床医学八年制教学计划表教学内容教学形式合计大课见习（含实验、电教、示教）技能训练病案讨论/pbl自学绪论和麻醉前准备22全身麻醉224输血与血液保护11神经阻滞麻醉和椎管内阻滞麻醉224气道控制123呼吸功能的监控22 4血流动力学监控1 1体外循环11氧供需平衡22休克213体液酸碱平衡的监控213外科营养213急性肺损伤（ali）和急性呼吸窘迫综合征（ards）213多器官功能障碍综合征22心肺脑复苏246疼痛学22专题答疑44总计328848五、教材：麻醉学曾因明主编，人民卫生出版社，978-7-117-09679-9 2008 2版4次六、主要参考资料：现代麻醉学第三版，庄心良主编，人民卫生出版社，978-7-117-05518-5，2009七、成绩评定办法（期末考试占成绩80%、平时成绩20%、考核方式：期末闭卷考试，平时成绩包括考勤、回答问题积极性、正确性）绪论和麻醉前准备introduction of anesthesiology& preoperative evaluation 一、 【目的要求】：1、 了解麻醉学近代发展史2、 了解麻醉及麻醉学的概念、麻醉工作的任务；3、 掌握麻醉前对病人的检查、评估与准备；4、 掌握麻醉前用药的种类及药理特点，使用原则。course objective: history of anesthesiology, the concepts of anesthesia and anesthesiology, classification of anesthesia, preoperative physical examination, evaluation and preparation,general anesthesia and the complications of general anesthesia and their management.二、 【讲授内容】：1、 麻醉学近代发展史2、 麻醉及麻醉学的概念、麻醉工作的任务；3、 麻醉前的一般准备。4、 麻醉前对病人的检查、评估与准备；麻醉前用药的种类及药理特点，使用原则。三、 【重点难点】：1、 麻醉前病人评估；2、 麻醉前用药的种类及药理特点，使用原则。course description：this course will start with introduction of modern history of anesthetic practice. then we will introduce the concepts of anesthesia and anesthesiology and the tasks of anesthesiologists. the following topics will cover preoperative evaluation and preparation; including the pharmacokinetic characteristics and the principle of usage of drugs used before anesthesia. and the content of preoperative evaluation and preparation and the usage of preoperative medication are key points in this course. 【讲授时数】：23 学时四、 【参考书】：现代麻醉学第三版 全身麻醉general anesthesia一、 【目的要求】：1. 掌握吸入麻醉药的分配系数、最低肺泡有效浓度（mac）的概念2. 掌握常用的全身麻醉方法及特点及全麻后病人的去向3. 掌握全麻后的常见并发症因。4. 熟悉全身麻醉的主要优缺点和适应症。5. 熟悉肌肉松弛药的分类和使用原则。6. 了解靶浓度控制输注。7. 了解肌肉松弛药的药理作用。course description：to master concepts of coefficient of distribution and minimum alveolar concentration (mac) of inhaled anesthetic, the application and characteristics of general anesthesia ways commonly used, where the patients recover from general anesthesia transported to and the complications of general anesthesia are requested. and students should be familiar with the principles of anesthesia selection, indications of general anesthesia, the classification and principles of muscle relaxants application. from this course, students will acquire general understanding target controlled infusion (tci) and the pharmacokinetic effect of muscle relaxants.二、 【讲授内容】：1. 睡眠、镇静和全麻醉的差别2. 吸入麻醉的特点和实施3. 静脉麻醉的特点和实施4. 常见全麻并发症三、 【重点难点】：1. 决定吸入麻醉药进入和排出体内的因素2. 全身麻醉的并发症三、 【教学时数】：11.5学时。四、 【自学内容】：肌肉松弛剂的作用原理常用全身麻醉药物的药理特点course description：we will introduce the knowledge of general anesthesia. we will help students differentiate the sleep, the sedation and the general anesthesia. then we will introduce the characteristics and the practice of inhalation anesthesia and intravenous anesthesia. the factors that determine intake and elimination of inhaled anesthetic and complications of general anesthesia are important and difficult to learn in this course.prerequisite：the prerequisite of this course includes, but is not limited to, the knowledge of, diagnostics and pharmacology. those who are not familiar with this knowledge are encouraged to read related text books and/or my lecture notes before hand.五、 【参考文献】：现代麻醉学 第三版六、【见习内容】：地点：手术室内容：麻醉前准备:患者准备、麻醉剂准备、常规麻醉药及抢救药准备；常用去极化/非去极化肌松药的作用机理、种类、特点以及应用；全身麻醉的诱导、维持、常见并发症。学时：2学时输血与血液保护allogeneic blood transfusion and blood conservation一、 【目的要求】：1. 掌握输血的概念与目的2. 掌握自体输血、成分输血的概念3. 掌握血液保护的概念与基本方法4. 熟悉输血并发症及处理5. 了解自体输血的方法和成分输血的制备course objective: this chapter is designed for undergraduate students in the school of medicine. five main points are covered in this chapter including: 1. concepts and purpose of allogenic blood transfusion. 2. autologus transfusion and component transfusion. 3. concepts and principal methods of blood conservation. 4. transfusion complications and the management. 5. methods of autologus transfusion and preparation of component transfusion. the first three main points need to be mastered, the forth point should be familiar with, and the fifth point should be understood by the students.二、 【讲授内容】：1. 输血的适应症、并发症、自体输血、成分输血2. 血液保护的基本概念与方法三、 【重点难点】：输血的指针、成分输血course description：the indications and complications of transfusion, autologus transfusion, and component transfusion are introduced. basic concepts and principal methods of blood conservation are introduced also.prerequisite：the prerequisite of this course includes, but is not limited to, the knowledge of histology, physiology, and components of blood system. those who are not familiar with that knowledge are encouraged to read related text books before hand.四、 【讲授时数】： 输血：11.5学时六、 【自学内容】七、 【参考书】：基础输血学2001年第一版神经阻滞麻醉和椎管内阻滞麻醉periphery nerve block and neuraxial block一、 【目的要求】： 1、 掌握常用局部麻醉药的药理特点2、 掌握局麻药的毒性反应及防治3、 熟悉常用神经阻滞的方法及优缺点4、 掌握椎管内麻醉的概念、适应症与禁忌症、严重并发症5、 熟悉椎管的解剖及椎管内麻醉的生理6、 熟悉影响椎管内麻醉平面的因素7、 了解神经丛阻滞的操作方法8、 了解椎管内麻醉操作方法objective: this chapter is designed for undergraduate students in the school of medicine. five main points are covered in this chapter including: 1. pharmacological characteristics of local anesthetics. 2. toxicity of local anesthetics and ways of prevention. 3. anatomy of peripheral nerve plexus and central nervous system. 4. concept of neuraxial block and its indications, contraindications and complications. 5. major periphery nerve plexus blocks. the first two and the 4th points need to be mastered. the 5th point needs to be familiar with and the 3rd point needs to be understood by students.二、 【讲授内容】：1、 局部麻醉药的药理及毒性反应2、 椎管内麻醉：椎管解剖、椎管内麻醉穿刺技术、影响椎管内麻醉的因素、椎管内麻醉的并发症、适应症与禁忌症3、 神经阻滞麻醉：臂丛神经阻滞麻醉、颈丛神经阻滞麻醉方法三、 【重点难点】：麻醉药的药理特点、毒性反应及防治、椎管内麻醉严重并发症description: basic concepts of peripheral nerve plexus block and neuraxial block are introduced, and the indication, contraindications and complications of peripheral nerve plexus block and neuraxial block are also introduced in this chapter.prerequisite: the prerequisite of this course includes, but is not limited to, the knowledge of the anatomy of major peripheral nerve plexus and neuraxial system. those who are not familiar with that knowledge are encouraged to read related textbook beforehand.四、 【讲授时数】：23学时五、 【自学内容】：椎管内麻醉的生理、颈丛神经阻滞麻醉、腰麻硬膜外联合麻醉六、 【参考书】：1、 现代麻醉学第三版 2、 anesthesia（miller）7th edition七、 【讲授时数】：2学时气道控制一、【目的要求】：1. 掌握呼吸道梗阻的原因及处理2. 掌握常见人工气道建立的方法及其特点。3. 掌握气管插管的适应症和并发症4. 熟悉气管插管的操作、困难气道的处理5. 了解肺隔离术objectives: to master the following key concepts and principles: 1 reasons and treatments of airway obstructions.2 methods and characteristics of common artificial airway managements.3 indications and complications of endo-tracheal intubation. to be familiar with：the process of endo-tracheal intubation and algorithm of difficult airway management.to acquire a general understanding: techniques of lung isolation.二、【讲授内容】：1. 上、下呼吸道梗阻的常见原因、临床表现及处理2. 通过面罩、喉罩、气管插管和气管切开所建立的人工通气技术的特点3. 气管插管的适应症、并发症。4. 气管插管术5. 困难气道的评估及处理原则三、【重点难点】：影响气道通畅的原因及处理description: brief contents of this chapter:usual reasons, clinical manifestations and treatments of upper and lower airway obstruction.characteristics of artificial airway management like mask ventilation, laryngeal mask airway (lma), endo-tracheal intubation and tracheostomy. indications and complications of endo-tracheal intubation.endo-tracheal intubation.evaluation and management of difficult airway.四、【讲授时数】：11.5学时五、【参考书】：现代麻醉学第三版六、【见习内容】新八教临床技能教室见习： 通过面罩、喉罩、气管插管和气管切开所建立的人工通气技术的特点气管插管的适应症、并发症。气管插管术困难气道的评估及处理原则呼吸功能的监控一、【目的要求】：1、 掌握呼吸功能监测的基本原理和方法2、 掌握围术期呼吸抑制的表现、病因及处理3、 熟悉呼吸机治疗的基本原理和常见通气模式二、【讲授内容】：1. 术中通气功能的监测2. 呼气末co2的监测及其意义3. 围术期呼吸抑制的表现、病因及处理4. 常用机械通气模式及其并发症三、【重点难点】：通气功能监测，中枢性和外周性呼吸抑制的表现和处理四、【讲授时数】：11.5学时五、【参考书】：临床监测学现代麻醉学第三版六、【见习内容】：地点：手术室内容：目前临床常用呼吸功能监测指标以及意义学时：1学时血流动力学监控教学大纲hemodynamic monitoring and management一、 【目的要求】：1. 掌握临床监测血流动力学的常用指标和特点；2. 掌握低血压的判断和调控；3. 熟悉直接动脉压导管和中心静脉导管放置方法4. 了解肺动脉漂浮导管放置方法；制性低血压的概念及实施原则。objective: this chapter is designed for senior undergraduate students in the school of medicine. they could master the indication of common clinical monitoring of hemodynamic , the judgement and regulation of hypotension; to be familiar with: catheterization of arterial catheter and central venous catheter. to acquire a general understanding: swan- ganz catheter, the method, concept and practical principle of control hypotension.二、 【讲授内容】：1、 临床常用的监测循环功能的指标和方法；2、 动脉血压测定的方法、意义，影响血压的因素；3、 中心静脉压监测和肺动脉漂浮导管监测的方法及临床意义；4、 低血压原因的分析、判断、血压的调控；5、 控制性低血压的概念、适应症和禁忌症，实施方法及注意事项。三、 【重点难点】：1、 动脉血压与组织血流灌注的关系。2、 低血压原因的分析description:this chapter will introduce the indicator of cardiac preload, such as systolic pressure variation and pulse pressure variation, a better predictors of volume than central venous pressure (cvp) or pulmonary capillary wedge pressure.四、 【讲授时数】：11.5学时五、 【自学内容】：1、 中心静脉和肺动脉导管的置入方法及并发症；2、 外周血管阻力的计算。六、【参考书】：现代麻醉学现代麻醉学技术。七、【见习内容】：地点：手术室内容：目前临床常用血流动力学监测指标以及意义学时：1学时体外循环cardiopulmonary bypass一、【目的要求】：1、 掌握体外循环的概念和临床应用。2、 熟悉体外循环的原理。3、 了解体外循环的材料、监测、体外膜式氧合的概念。objectives:this chapter is designed for undergraduate students in the school of medicine. the students should master the following key concepts of cardiopulmonary bypass and the clinical indication of the cardiopulmonary bypass. to be familiar with: the principle of cardiopulmonary bypass. to acquire a general understanding: the material during cardiopulmonary bypass.二、【讲授内容】：1、 体外循环的历史和基本概念2、 体外循环的原理和方法3、 体外循环的材料和监测4、 体外循环的临床应用（治疗作用和生命支持作用）5、 体外膜式氧合器氧合疗法（ecmo）的概念、临床应用和发展趋势三、【重点难点】：1、 体外循环的发展历程，在临床各个领域的应用将来的发展趋势。2、 体外膜式气合器氧合疗法的概念，国内外应用现状，未来的发展前景。descriptionthis chapter will introduce the principle and concept of the cardiopulmonary bypass. we should master the clinical indications of the cardiopulmonary bypass.四、【讲授时数】：11.5学时五、【参考书】：体外循环学（龙村主编）现代麻醉学（第三版）氧供需平衡的监控monitoring and control of the balance between oxygen supply and demand一、【目的要求】：1、 掌握氧供、氧耗、氧需、缺氧的概念；2、 掌握术中氧运输过程的监测3、 熟悉氧供需平衡监测；4、 熟悉氧疗的基本概念和方法objectives:this chapter is designed for undergraduate students in the school of medicine. to master the following key concepts and principle: oxygen supply, oxygen consumption, oxygen demand, hypoxia, and the monitoring item of oxygen transportation process. to be familiar with: the balance between oxygen supply and demand. to acquire a general understanding: the basic concepts and methods of oxygen therapy二、【讲授内容】：1、 氧输送的过程2、 氧供的监测和计算方法3、 氧供需平衡的监控4、 氧疗的基本概念和方法三、【重点难点】：氧运输的过程及监测、氧供和氧耗的计算description：the brief contents in this chapter are including: oxygen transport process: o2 cascade, the influence factors for oxygen transport, the calculation formula for oxygen supply, the monitoring during oxygen transport: arterial oxygen saturation, oxygen pressure, oxygen capacity, oxygen-hb dissociation curve, shunt fraction,the monitoring of the balance between oxygen supply and demand, the basic concepts and methods of oxygen therapy四、【讲授时数】：11.5学时五、【参考书】：现代麻醉学（第三版）休克shock一、 【目的要求】：1、 掌握休克的分类；2、 掌握休克的临床表现、诊断、急救处理和治疗要点；3、 熟悉休克的特殊监测；4、 熟悉使用血管活性药物的适应症及注意事项；5、 了解休克治疗的进展。objective: this chapter is designed for undergraduate students in the school of medicine. five main points are covered in this chapter including: 1. cellular alterations. 2. impairment of cellular metabolism. 3. organ response. 4. types of shock. 5. treatment for shock. all of the above contents need to be well understood and mastered by the students.二、 【讲授内容】：1、 休克的概念、病因、分类2、 休克时微循环的变化特点及与疾病发展变化的关系3、 休克的临床表现4、 休克的急救措施，综合治疗要点5、 休克液体治疗的原则和注意事项三、 【重点难点】：休克的诊断和处理description：in the first part of this course, we will introduce the pathogenesis and pathophysiology of shock, including cellular alteration, impairment of cellular metabolism, neuroendocrine response, cardiovascular response, pulmonary response and renal response. and then, six specific forms of shock will be introduced, including cardiogenic, hypovolemic, neurogenic, anaphylactic, septic and traumatic shock. at last, the approach to the patient with shock will be introduced, including monitoring, diagnosis and treatment. prerequisite：the prerequisite of this course includes, but is not limited to, the knowledge of histology, physiology, and pathology of some important organs, such as, brain, heart, lung, kidney. those who are not familiar with that knowledge are encouraged to read related text books before hand.四、【讲授时数】：11.5学时五、【参考书】：现代麻醉学（第三版）体液酸碱平衡的监控fluid，electrolyte and acid-base balance一、【目的要求】：1、 掌握各型水钠代谢障碍，低、高钾病理、临床症状、治疗原则；2、 掌握各型酸碱中毒的病理生理、临床症状、诊治原则；3、 熟悉正常水、电解质代谢和酸碱平衡的基础理论；4、 熟悉体液失调临床处理的基本原则。5、 了解其他电解质失衡的临床表现和处理原则；objective: this chapter is designed for undergraduate students in the school of medicine. five main points are covered in this chapter including: 1. clinical manifestations and principles of therapy of dehydration and hypokaleamia and hyperkaleamia. 2. diagnosis and treatment of simple acid-base balance. 3. basic theories of normal homeostasis of internal environment. 4. distribution and adjustment of fluid in different compartment. 5. concept and treatment of other disturbance of internal environment. the first two main points need to be mastered, the third and forth points should be familiar with, and the fifth point should be understood by the students.二、【讲授内容】：1. 各型水钠代谢障碍，低、高钾病理、临床症状、治疗原则；2. 各型酸碱中毒的病理生理、临床症状、诊治原则；3. 正常水、电解质代谢和酸碱平衡的基础理论；4. 体液失调临床处理的基本原则。三、【重点难点】：重点：各型脱水，低、高钾血症，代谢性酸中毒的诊治原则。难点：各型脱水的诊断，酸碱失衡的临床分析方法。description：the concepts of dehydration and electrolyte abnomities and acid-base disturbance are introduced, also are the clinical manifestations and principles of therapy.prerequisite：the prerequisite of this course includes, but is not limited to, the knowledge of normal components in the body fluid. those who are not familiar with that knowledge are encouraged to read related text books beforehand.四、【讲授时数】：2学时五、【参考书】：张文武主编，急诊内科学，第六篇 水、电解质和酸碱平衡失调，589635。人民卫生出版社外科营养surgical nutrition一、【目的要求】：1、 掌握营养状况的评估方法；2、 熟悉饥饿及应激状态时机体的代谢变化；3、 掌握营养支持的实施原则，肠内以及肠外营养实施的方法、适应症以及并发症；4、 掌握全胃肠外营养（tpn）的配制原则。5、 了解七种营养素的基本生理功能；6、 了解特殊病人的营养支持。objective: this chapter is designed for undergraduate students in the school of medicine. six main points are covered in this chapter including: 1. assessment of nutrition status. 2. principles，methods，indications，and complications of enteral or parenteral nutrition. 3. principles for making out a total parenteral nutrition prescription. 4. metabolic changes of body at hungry or stress. 5. physiological functions of seven essential nutrient. 6. nutrition support for patients with specific diseases. the first three main points need to be mastered, the forth and fifth points should be familiar with, and the sixth point should be understood by the students.二、【讲授内容】： 目的要求中的内容。三、【重点难点】： 重点：营养支持的实施原则，肠内以及肠外营养实施的方法、适应症以及并发症，tpn的配制原则。 难点：营养状况的评估方法，tpn的配制方法。description：malnutrition is very common in critically ill patients. the course introduces the indications and complications of enteral or parenteral nutrition, and the detailed methods are also introduced. prerequisite：the prerequisite of this course includes the knowledge of seven essential nutrient. those who are not familiar with that knowledge are encouraged to read related text books before hand.四、【讲授时数】： 2学时五、【参考书】：临床营养基础。lubos sobotka 主编，复旦大学出版社急性肺损伤（ali）和急性呼吸窘迫综合征（ards）ali & ards一、【目的要求】：1、 掌握ali和ards的定义和诊断标准；2、 掌握ali与ards的临床表现和诊治原则。3、 熟悉ards的病理改变和病理生理过程和掌握ards呼吸支持治疗的原则。4、 了解ali和ards的病因；course objective: this chapter is designed for undergraduate students in the school of medicine. five main points are covered in this chapter including: 1. concepts and diagnosis of acute lung injury（ali）and acute respiratory distress syndrome（ards）. 2. clinical manifestations and principles of therapy of ali & ards. 3. principles of ventilation support for patients with ards. 4. pathophysiological and physiological changes of ards. 5. etiology of ali & ards. the first three main points need to be mastered, the forth point should be familiar with, and the fifth point should be understood by the students.二、【讲授内容】： 目的要求中的内容。三、【重点难点】：重点：ali与ards的诊断标准，临床表现与治疗原则。难点：ali与ards的治疗原则。course description：the concept and diagnostic standard，as well as principles of treatment for patients with ali &