基础科普|麻醉是什么？

随着我国经济的发展(现每年GDP增长7.5%)和社会的进步(医疗卫生支出占GDP总量的比例每年以超过15%的增长)，我国整个医疗卫生的服务总量，当然也包括麻醉学科的工作总量将大大增加。

目前，中国大陆每年的手术量将由现在的3500万例左右增加到5000万例；手术室外的麻醉可能将达到2000万例/年；每年1400万例分娩，越来越多的产妇将接受麻醉科医师提供的无痛分娩；疼痛，特别是术后急性疼痛、各种慢性疼痛、晚期癌痛、康复锻炼疼痛等将受到麻醉科医师和麻醉背景的疼痛专科医师们的普遍的关注与诊治；ICU病床将由现在的医院总床位数的2%左右增加到3-5%。（小编注：所以麻醉学科涉及到手术室、手术室外包括各种无痛检查、疼痛治疗、ICU病房，范围相当广）

麻醉医生已经是舒适化医疗的主角。“医院要发展，麻醉需先行”。

然而，作为幕后英雄，患者及普通民众对麻醉学科及麻醉医生的了解仍较少。本期我们面向普通公众，普及下“麻醉是什么”（因为是普及，中文在前，学英语的直接拉到后面）

小百科

什么是麻醉？

"麻醉"是一个医学术语，是人们在手术前和手术期间获得的不同类型的麻醉药物。这些药物是为了确保你在手术过程中不会感到疼痛。在某些情况下，比如当你被"睡觉"做手术时，麻醉药物也会阻止你事后记住它。（小编注：就像喝醉断片一样）

麻醉药物是由一位叫"麻醉医师"的医生提供的。有时也涉及"麻醉护士"。这些护士接受麻醉方面的特殊培训。

麻醉有哪些不同类型？

麻醉有3种主要类型：

●局部麻醉-这种麻醉使用药物使您的身体的一小部分麻木，因此您不会感到疼痛。它以霜剂，凝胶剂或喷雾剂的形式在皮肤上使用。也可以通过注射来给予。当您进行局部麻醉时，您可能会醒着。

麻醉医生在进行皮肤或乳房活检等小手术之前先进行局部麻醉。（活检涉及使用针头取一小块组织样本。）（小编注：局部麻醉往往比较简单，是外科医生实施，是不需要麻醉医生出手的哦）

●区域麻醉–这种麻醉可以阻止身体某一部位的疼痛，例如手臂，腿部或下半身。如果您进行区域麻醉，您可能会清醒。或者，您可能会获得称为“镇静剂”的药物来使您放松并感到困倦。镇静剂通过一根细管进入静脉内，称为“静脉注射”。

一种类型的区域麻醉称为“脊柱阻滞”。麻醉医生将一根小针刺入您的下背部，并注射药物使您的脊髓神经麻木。它可以用于腿部或腹部内部的手术。另一种类型是“硬膜外”。麻醉一身用一根针将一根小管（称为“导管”）插入您的下背部，靠近脊柱神经。有些妇女在分娩时会硬膜外麻醉。其他人则需要进行手术或控制术后疼痛。（小编注：就是常说的“半身麻醉”）

●全身麻醉–这种麻醉会使您失去知觉，因此您在手术过程中不会感觉，看到或听到任何声音。有些药物是通过静脉注射给药的。也可以通过如气体。您可能还会通过呼吸管路来帮助您呼吸，麻醉医生将在全身麻醉期间在您入睡时将导管小心地放入您的喉咙，并在醒来之前将其取出。（小编注：很多患者醒来都说是闷睡的，其实不全是啦。）

麻醉医生做什么？

麻醉医生会在您手术前与您会面，并向您询问许多问题，包括：

●您有健康问题吗？

●您是否有牙齿问题，例如牙齿松动或假牙？

●您服用什么药物，包括非处方药和补品？

●您是否吸烟，饮酒或使用任何非法药物？

●您对食物或药物过敏吗？

●您或您的任何亲戚是否有麻醉药物问题？

您所获得的麻醉类型取决于：

●您对以上问题的回答

●您正在进行的手术或步骤类型

在某些情况下，您可以在不同类型的麻醉之间进行选择。

您的麻醉医生还会告诉您如何进行麻醉并回答您的任何问题。在手术过程中，他们将不断检查您的呼吸，血压和心率。如果您是全身麻醉，麻醉医生还应确保您保持睡眠状态。

我会在全身麻醉下醒来吗？

在全身麻醉下醒来的情况非常罕见（每15,000例手术中只有不到1名患者醒来）。您的麻醉医生会不断调整药物以免您术中醒来。（小编注：大家可能看过有关术中知晓的下面这部电影《awake》,术中知晓是很恐怖的一件事。目前随着监护技术发展，术中知晓的发生率更低了，完全可以放心哈）

麻醉有副作用吗？

每种麻醉都有可能的副作用。

如果您有脊髓麻醉或硬膜外麻醉，您手术后持续几个小时麻木，然后再逐渐消失。其他副作用可能包括：

●头痛–持续几天的头痛的几率很小。有时称为“脊柱性头痛”。它通常会自行消失，但是止痛药和其他治疗方法可能会有所帮助。

●排尿困难–某些患者在手术后数小时内无法排空膀胱，直到麻醉剂消失为止。

如果您是全身麻醉，醒来后短时间内可能会感到有点昏昏欲睡或感到疲倦。其他副作用可能包括：

●感到胃不适（恶心）和呕吐（呕吐）–您的麻醉医生可以为您提供解决此问题的药物。

●喉咙痛–如果您有气管导管，可能会发生这种情况。通常情况下会很快好起来。

关于麻醉我还应该知道些什么？

保证您的安全是麻醉医生的主要任务（小编注：”手术医生看病，麻醉医生保命”这句话可不是说着玩的，从刚出生的婴儿到百岁老人，手术部位和方法可能是一样的，但是年龄变化，机体功能不同，对麻醉要求可是大不相同。术中发生任何突发情况，危机到患者生命的意外事件，手术医生不可能及时发现和处理，而是需要一旁认真监护的麻醉医生去处置的，这样才能保证手术安全进行）。手术之前，您应该向麻醉医生询问有关麻醉的风险和益处以及最适合您的麻醉类型的任何问题。手术后，您的麻醉医师会在您康复时对您进行检查。

What is anesthesia?"Anesthesia" is a medical term for different types of medicine people get before and during surgery or another procedure. These medicines are given to make sure you do not feel pain during the procedure. In some cases, like when you are "put to sleep" for surgery, the anesthesia medicines also prevent you from remembering it afterwards.

Anesthesia medicines are given by a doctor called an "anesthesiologist." Sometimes a "nurse anesthetist" is involved, too. These are nurses with special training in anesthesia.

What are the different types of anesthesia?There are 3 main types of anesthesia:

●Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain. It can be given as a cream, gel, or spray on the skin. It can also be given by an injection (shot) into the skin. You might be awake when you get local anesthesia.

Anesthesiologists give local anesthesia before minor surgery such as a skin or breast biopsy. (A biopsy involves taking a tiny sample of tissue using a needle.)

●Regional – This type of anesthesia blocks pain in one area of your body, such as an arm, leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives." Sedatives are given through a thin tube that goes into a vein, called an "IV."

One type of regional anesthesia is called a "spinal block." The anesthesiologist puts a small needle in your lower back, and injects medicine to numb the nerves in your spine. It can be used for surgery done on your legs or inside your belly. Another type is an "epidural." The anesthesiologist uses a needle to put a small tube (called a "catheter") into your lower back, near the nerves in your spine. Some women get an epidural during childbirth. Other people get one for a surgical procedure or to control pain after surgery.

●General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during surgery. Some of the medicines are given through an IV. Others are gases that you breathe. You might also get a breathing tube to help you breathe. If this happens, the anesthesiologist will carefully place the tube in your throat while you are asleep during general anesthesia, and remove it before you wake up.

What does an anesthesiologist do?An anesthesiologist will meet with you before your surgery and ask you many questions, including:

●Do you have any health problems?

●Do you have any dental problems, such as loose teeth or false teeth?

●What medicines do you take, including over-the-counter medicines and supplements?

●Do you smoke, drink alcohol, or use any illegal drugs?

●Do you have any allergies to foods or medicines?

●Have you or any of your relatives ever had a problem with anesthesia medicines?

The type of anesthesia you get depends on:

●Your answers to the questions above

●The type of surgery or procedure you are having

In some cases, you might have a choice between different types of anesthesia.

Your anesthesiologist will also tell you how your anesthesia will be given and answer any questions you have. They will continually check your breathing, blood pressure, and heart rate during the procedure. If you have general anesthesia, your anesthesiologist also makes sure you stay unconscious.

Can I wake up during general anesthesia?It is very rare to wake up during general anesthesia (less than 1 patient in every 15,000 operations). Your anesthesiologist constantly adjusts the medicines to keep you from waking up.

Are there any side effects from anesthesia?Each type of anesthesia has possible side effects.

If you have a spinal block or epidural, the numbness will last for a few hours after your procedure before wearing off. Other side effects can include:

●Headache – There is a small chance of getting a type of headache that can last for several days. This is sometimes called a "spinal headache." It usually goes away on its own, but pain-relieving medicines and other treatments can help.

●Trouble urinating – Some patients have trouble emptying their bladders for a few hours after surgery until the anesthetic wears off.

If you have general anesthesia, you will likely feel a little groggy or confused for a short time after waking up. Other side effects can include:

●Feeling sick to your stomach (nausea) and throwing up (vomiting) – Your anesthesiologist can give you medicines for this problem.

●A sore throat – This can happen if you had a breathing tube. It usually gets better quickly.

What else should I know about anesthesia?Keeping you safe is your anesthesiologist's main concern. Before surgery, you should feel comfortable asking your anesthesiologist any questions about the risks and benefits of anesthesia, and the type of anesthesia that is best for you. After surgery, your anesthesiologist will check on you as you recover.

参考资料： www.uptodate.com