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麻醉常用评分标准

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发表于 2017-12-21 19:37:15 | 显示全部楼层 |阅读模式
麻醉常用评分标准★全麻效果评级标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1、麻醉诱导平稳、无躁动、无呛咳及血液动力学的变化,插管顺利无损伤。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2、麻醉维持期深浅适度,既无明显的应急反应,又无呼吸循环的抑制,肌松良好, 为手术提供良好的条件。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3、麻醉结束,苏醒期平稳,既没有过早或过迟苏醒,呼吸和循环各项监测正常,肌 松恢复良好,拔管恰当,无不良反应。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4、无并发症。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1、麻醉诱导时稍有呛咳和血液动力学的改变。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2、麻醉维持期深度掌握不够熟练,血液动力学有改变,肌松尚可,配合手术欠理想。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3、麻醉结实缝皮时病人略由躁动,血压和呼吸稍有不平稳。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4、难以防止的轻度并发症。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1、麻醉诱导经过不平稳,插管有呛咳、躁动,血液动力学不稳定,应激反应强烈。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2、麻醉维持期深浅掌握不熟练,致使应激反应激烈,呼吸和循环的抑制或很不稳定,肌松不良,配合手术勉强。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3、麻醉结束,病人苏醒冗长伴有呼吸抑制或缝皮时病人躁动、呛咳;被迫进行拔管,拔管后呼吸恢复欠佳。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4、产生严重并发症。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★椎管内麻醉(硬、腰、骶)效果评级标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:麻醉完善、无痛、肌松良好、安静,为手术提供良好条件,心肺功能和血流动力学 保持相对稳定。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:麻醉欠完善,有轻度疼痛表现,肌松欠佳,有内脏牵引痛,需用镇静剂,血流动力学有波动。(非病情所致)‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:麻醉不完善,疼痛明显或肌松较差,呻吟躁动,辅助用药后,情况有改善,但不够理想,勉强完成手术。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:需该其他麻醉方法,才能完成手术。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★神经阻滞效果评级标准(颈丛、神经臂丛、下肢等)‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:阻滞范围完善,病人无痛、安静,肌松满意,为手术提供良好条件;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:阻滞范围欠完善,肌松效果欠满意,病人有疼痛表情;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:阻滞范围不完善,疼痛较明显,肌松效果较差,病人出现呻吟、躁动,辅助用药后,情况有所改善,但不够理想,勉强完成手术;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
级:麻醉失败,需改用其他麻醉方法后才能完成手术。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ramsay镇静评分‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1分为不安静、烦躁;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2分为安静合作;;;3分为嗜睡,能听从指令‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4分为睡眠状态,但可唤醒;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
5分为呼吸反应迟钝;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
6分为深睡状态,呼唤不醒。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
其中24分镇静满意,56分镇静过度。 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
BCSBruggrmann comfort scale)舒适评分‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0分为持续疼痛;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1分为安静时无痛,深呼吸或咳嗽时疼痛严重;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2分为平卧安静时无痛,深呼吸或咳嗽时轻微疼痛‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3分为深呼吸时亦无痛;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4分为咳嗽时亦无痛。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Steward苏醒评分‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
清醒程度:    完全苏醒          对刺激有反应            对刺激无反应‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
呼吸道通畅程度:可按医师吩咐咳嗽    不用支持可以维持呼吸道通畅  呼吸道需要予以支持‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
肢体活动度:  肢体能作有意识的活动  肢体无意识活动          肢体无活动‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
评分在4分以上方能离开手术室或恢复室‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ramsay 镇静分级标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅰ级:病人焦虑和(或)烦躁不安; ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅱ级:安静合作,定向准确;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅲ级:仅对指令有反应;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅳ级:入睡,轻叩眉间或大声呼唤反应敏捷;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅴ级:入睡,轻叩眉间或大声呼唤反应迟钝;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅵ级:入睡,对刺激无反应。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅱ—Ⅴ级为理想镇静状态。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★气管插管时肌松程度分级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1级:肌松差,呛咳及肢体活动,插管困难;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2级:肌松一般,呛咳,可插管;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3级:肌松较好,声门轻度活动,不妨碍插管;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4级:肌松完全,插管容易,无任何反应。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★内脏牵拉反应‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0级:病人安静,无痛及不适感,无恶心及呕吐;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1级:轻度不适,恶心,无牵拉痛、呕吐;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2级:诉恶心,轻度牵拉痛,无呕吐;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3级:牵拉痛明显,有恶心、呕吐、鼓肠。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★清醒程度分级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0级:病人入睡,呼唤无任何反应;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1级:病人入睡,呼唤时有肢体运动或睁眼、头颈部移动;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2级:病人清醒,有1级的表现同时能张口伸舌;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3级:病人清醒,有2级的表现并能说出自己的年龄或姓名;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4级:病人清醒,有3级的表现并能认识环境中的人或自己所处的位置。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★改良的OAA/S评分(The Observers Assessment of Alertness/Sedation Scale)‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1级:完全清醒,对正常呼名的应答反应正常;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2级:对正常呼名的的应答反应迟钝;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3级:对正常呼名无应答反应,对反复大声呼名有应答反应;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4级:对反复大声呼名无应答反应,对轻拍身体才有应答反应;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
5级:对拍身体无应答反应,但对伤害性刺激有应答反应。对伤害性刺激无反应为麻醉。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
一般而言,手术所需要的镇静深度为34级。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
MAC离院评分标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1.麻醉后病人生命体征平稳,且与术前基础水平接近>1小时,2分;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2.病人必须认知人员、地点、时间,能穿衣避让和自主行走,2分;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3.病人无恶心、呕吐,2分;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4.无剧烈疼痛、出血,2分;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
5.疼痛的部位、类型和范围与手术相符,2分。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★改良Macnab疗效评定标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
优:症状完全消失,恢复原来的工作和生活;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
良:有轻微症状,活动轻度受限,对工作生活无影响;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
可:症状减轻,活动受限,影响正常工作和生活;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
差:治疗前后无差别,甚至加重。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★焦虑视觉模拟评分(anxiety visual analog test,AVAT‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
在一根长100mm的直线上,0代表完全无焦虑,100代表最剧烈的焦虑,由患者根据其自觉焦虑程度在直线上做标记,记录长度(mm)。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Tarlov 神经功能评分标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0级:下肢完全瘫痪;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1
级:可觉察的下肢关节运动;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2
级:下肢可自由运动,但无法站立;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3
级:可站立但无法行走;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4
级:下肢运动功能完全恢复,能正常行走。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★病人合作评分‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1分:不合作;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2
分:稍合作,需固定四肢;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3
分:稍合作,但多语;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4
分:合作良好;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
5
分:完全合作。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★术后满意度评分‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1分:非常不舒服;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2
分:比较舒服;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3
分:非常舒服。 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★寒战评分‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:无寒战;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1
:面部或颈部轻度肌束寒战或心电图有杂音;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2
:超过1个肌群有可见的寒战;‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3
:多个肌肉包括全身活动。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
NIPS评分-新生儿疼痛评估量表‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
面部表情‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:肌肉放松:面部表情平静,中性表情‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1:皱眉头:面部肌肉紧张,眉头和下巴都有皱纹(负面的面部表情――鼻子、嘴巴和下巴)‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
哭闹‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:不哭:安静、不哭‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1:呜咽:间断的、轻微的哭泣‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2:大哭:大声尖叫、声音不断响亮的、刺耳的、持续的‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
呼吸形态‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:放松:孩子平常的状态‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1:呼吸形态改变:不规则、比平常快,噎住、屏气‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
手臂‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:放松或受限:没有肌肉的僵直,偶尔手臂随机的的运动‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1:屈曲、伸展:紧张、手臂伸直、很快地伸展或屈曲‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:放松或受限:没有肌肉的僵直,偶尔腿部随机的运动‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1:屈曲、伸展:紧张、手臂伸直、很快地伸展或屈曲‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
觉醒的状态‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0:入睡、觉醒:安静、平和、入睡或觉醒或平静的‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1:紧急、局促不安:激惹‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
NIPS评分适用于婴儿、幼儿或任何不会讲话的孩子,对于严重的生长发育迟缓或严重的智力障碍,NIPS在使用的时候要与家长合作,以便更好地代表孩子的疼痛行为。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★屏气试验‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
心功能分级  屏气试验          ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅰ级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
30
秒以上  普通体力劳动、负重、快速步行、上下坡,不感到心慌气喘              ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅱ级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
20-30
  能胜任正常活动,但不能跑步或作较用力的工作,否则心慌气喘‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅲ级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
10-20
    必须静坐或卧床休息,轻度体力活动后即出现心慌气喘 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅳ级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
10
秒以内  不能平卧,端坐呼吸,肺底罗音,任何轻微活动即出现心慌气喘‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★高血压分期‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
第一期:血压达到确诊高血压的水平,但无器官损害,临床上无心、脑、肾受损的表现‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
第二期:高血压并有器官损害,但有功能代偿能力,临床上有下列表现之一者:①体检、X线、心电图或超声心动图检查见有左心室肥厚;②眼底动脉普通或局部变窄;③蛋白质或和血浆肌酐浓度升高。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
第三期:高血压伴有器官损害,并失代偿,临床上有以下表现之一者:①脑出血或高血压脑病;②左心衰竭;③肾功能衰竭。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★心绞痛分级         ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
    任何体力活动无心绞痛发作‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅰ级  日常体力活动不引起心绞痛、但快速步行,登楼梯,剧烈活动或长时间快速费力工作或娱乐,出现心绞痛‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅱ级  日常体力活动轻度受限,登楼梯、爬山、餐后散步或登高、寒冷和大风、情绪紧张或睡醒后段时间爱女出现心绞痛‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅲ级  日常体力活动明显受限,以正常步速,短距离散步或登一段楼梯即出现心绞痛,休息后症状可缓解 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅳ级  任何体力活动均可诱发心绞痛,静息时也可发作‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★呼吸困难程度分级‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
0
无呼吸困难症状‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
Ⅰ能根据需要远行,但是疲劳,不愿步行‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
步行距离有限制,走一或二条街后需停步休息‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
短距离走动即出现呼吸困难‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
静息时也出现呼吸困难 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★格拉斯哥(Glasgow)评分标准‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
格拉斯哥评分标准是国际上通用的评价病人意识和判断预后的方法。评分3~5分,表示有严重脑损害,文献报道其病死率是6~8分的3倍。动态观察评分有助与了解病情变化方向.注意运动评分左侧右侧可能不同,用较高的分数进行评分。改良的GCS评分应记录最好反应/最差反应和左侧/右侧运动评分。‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
                 言语反应            运动反应 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1.‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
不睁眼          无反应              无反应 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2.‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
疼痛刺激时睁眼  不理解、无意识发音  去脑强直 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3.‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
呼唤睁眼        不确切、不能交谈    去皮质状态 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4.‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
自由睁眼        可交谈、言语紊乱不上 有疼痛躲避反应,但不定向 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
5.‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
对答切题        能推避疼痛刺激 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
6 .‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í

听从言语命令运动 ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★格拉斯哥预后评分:‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
评分 等级    描述‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
5 恢复良好  恢复正常生活,尽管有轻度缺陷‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
4 轻度残疾  残疾但可独立生活;能在保护下工作‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
3 重度残疾  清醒、残疾,日常生活需要照料‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
2 植物生存  仅有最小反应 (如随着睡眠/清醒周期,眼睛能睁开) ‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1 死亡  死亡‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
★血气分析临床分级标准 血气分析临床分3:‹'D>Ð!ÓÉKJbbs.zjmzzk.com K ±Î¦hÖ4Í
1)轻度缺氧: PaO 2 6.688.00kPa5060mmHg),SaO 2 >80%PaCO 2 <6.67kPa50mmHg;&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
2)中度缺氧: PaO 2 4.006.67kPa3050mmHg),PaCO 2 >7.33kPa55mmHg;&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
3)重度缺氧: PaO 2 <4.00kPa30mmHg),SaO 2 <60%PaCO 2 >10.00kPa75mmHg &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
临床表现将缺氧分为轻、中、重三度:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
轻度缺氧:球结膜充血,呼吸稍快,血压正常,中枢神经易激惹,注意力不集中,智力减退,定向力障碍。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
中度缺氧:球结膜轻度水肿,呼吸费力,鼻翼煽动,唇甲紫绀,面色潮红,血压正常或增高,心率加快,中枢兴奋性增高,烦躁,谵妄。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
重度缺氧:球结膜充血水肿,血压下降,心律失常,张口呼吸,紫绀,出现呼吸抑制,神情恍惚,昏迷。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
贫血的临床分级    &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
分级      血红蛋白(g/L        临床表现 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
轻度&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
120~91(12~9.1g/dl)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

症状微&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
中度&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
90~61(9~6.1g/dl)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

体力劳动后感到心慌、气短 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
重度&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
60~31(6~3.1g/dl)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

卧床休息时也感心慌、气短 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
极度&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
< 30(3.0
以下g/dl)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
常合并贫血性心脏病 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★肌力分级:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
评分 描述&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
5
力量正常&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
4+
在强负荷下力量轻度下降&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
4
能够对抗中等负荷&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
4-
能够对抗轻度负荷&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
3
能对抗重力完成运动&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
2
不能对抗重力&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
1
仅有肌肉收缩,可能只能被触及&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
0
无任何运动&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★运动功能障碍程度评估:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
分级    上肢                          下肢&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
1      正常                          正常&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
2
      远端关节能活动(包括腕关节      远端关节能活动(包括踝关节 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

及手指各关节)                  及脚趾各关节)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
3
      臂可上举,肘可屈伸              腿可上举,膝可屈伸&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
4
      只能在床上屈伸                  只能在床上屈伸&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
5      完全不能活动                    完全不能活动&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★)Apgar儿童(<4岁)评分&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
---------------------------------------------------------------------------------------&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
---------------------------------------------------------------------------------------&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
0&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
1&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
2
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
---------------------------------------------------------------------------------------&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
皮肤颜色:          青紫或苍白  身体红、四肢青紫      全身红 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
心率(/)                 小于100次/分        大于100 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
弹足底或导管插鼻反应 :无反应    有些动作如皱眉      哭、喷嚏 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
肌张力               松弛      四肢略屈曲            四肢能活动 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
呼吸 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

      慢、不规则            正常、哭声响&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
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★美国麻醉师协会(ASA)根据病人体质状况和对手术危险性进行分类,于麻醉前将病人分为5级: &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Ⅰ级:正常健康。除局部病变外,无系统性疾病。 Ⅱ级:有轻度或中度系统性疾病。 Ⅲ级:有严重系统性疾病,日常活动受限,但未丧失工作能力。 Ⅳ级:有严重系统性疾病,已丧失工作能力,威胁生命安全。 Ⅴ级:病情危篙,生命难以维持的濒死病人。 如系急诊手术,在评定上述某级前标注“急”或“E”。 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Ⅰ、Ⅱ级病人,麻醉和手术耐受力良好,麻醉经过平稳。Ⅲ级病人麻醉中有一定危险,麻醉前准备要充分,对麻醉期间可能发生的并发症要采取有效措施,积极预防。 Ⅳ级病人麻醉危险性极大, Ⅴ级病人病情极危重,麻醉耐受力极差,随时有死亡的威协,麻醉和手术异常危险,麻醉前准备更属重要,做到充分、细致和周到。 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★张口度(这里指上下齿间的距离) &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
正常:                4.5cm&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Ⅰ度张口困难:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
2.5-3.0cm
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Ⅱ度张口困难:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
1.2-2.0cm
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Ⅲ度张口困难:        1.0cm&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★癌痛程度评估&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
主诉疼痛分级法(VRS):&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Ⅰ级:无痛;Ⅱ级:轻度,虽有痛感,但可以忍受,睡眠不受干扰,能正常生活;Ⅲ级:中度,疼痛明显,不能忍受,要求止痛,睡眠受干扰;Ⅳ级:重度,剧烈疼痛可伴有植物神经功能紊乱表现,或被动体位,严重干扰睡眠;Ⅴ级:极度,患者所想象的最严重的疼痛。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
010级线性视觉模拟评分法(visual analogue scale VAS):在标尺的两端标有从010 的数字,数字越大,表示疼痛强度越大。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
0级为无痛;14级为轻度疼痛;56级为中度疼痛;79级为严重疼痛;10级以上为剧烈疼痛。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
Child肝功能分级法&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
检查项目                    &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
A&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
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B&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
C&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

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血清胆红素(umolL       <34.2&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
34.2
5l.3&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

51.3 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
血清清蛋白(gL          35&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
30
35&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

30 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
腹水&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

            容易控制            难于控制 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
神经精神症状                                              重昏迷 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
营养状态&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

                                &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
                    &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
ChildPUgh改良肝功能计分分级法&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
检查项目&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
1
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
2
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
3
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
血清胆红素(pmolL    342&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
34
25l.3 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
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813 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
血清清蛋白(gL&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

35&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
30
35&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
30 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
凝血酶原时间延长(S    3&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
3
5&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
5 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
腹水                                  少/中&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

明显 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
脑病&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;

                                    中重&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
注:积分5-7分为A级,8-10分为B级;11-15分为C级。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★按照WHO提出的癌痛治疗的5个主要原则给药:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
一、口服给药。简便、无创、便于患者长期用药,对大多数疼痛患者都适用。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
二、按时给药。注意:是“按时”给药,而不是疼痛时才给药。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
三、按三阶梯原则给药。按患者疼痛的轻、中、重不同程度,给予不同阶梯的药物。下面我们分别列举各阶梯中的常用药物。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
第一阶梯轻度疼痛给予非阿片类(非甾类抗炎药)加减辅助止痛药。注意:非甾类止痛药存在最大有效剂量(天花板效应注)的问题。(常用药物包括扑热息痛、阿司匹林、双氯芬酸盐、加合百服宁、布洛芬、芬必得(布洛芬缓释胶囊)、消炎痛、吲哚美辛、意施丁(吲哚美辛控释片)等等。)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
第二阶梯中度疼痛给予弱阿片类加减非甾类抗炎药和辅助止痛药。弱阿片类药物也存在天花板效应。(常用药物有可待因、强痛定、曲马多、奇曼丁(曲马多缓释片)、双克因(可待因控释片)等等。)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
第三阶梯重度疼痛给予阿片类加减非甾类抗炎药和辅助止痛药。强阿片类药物无天花板效应,但可产生耐受,需适当增加剂量以克服耐受现象。以往认为用吗啡止痛会成瘾,所以不愿给患者用吗啡,现在证明这个观点是错误的———使用吗啡的癌痛患者极少产生成瘾性。(常用药物有吗啡片、美菲康(吗啡缓释片)、美施康定(吗啡控释片,可直肠给药)等等。但是,度冷丁这一以往常用的止痛药,由于其代谢产物毒性大等因素,未被推荐用于控制慢性疼痛。 另外,一些辅助药物的使用增加了止痛的疗效,减少了止痛药的剂量,起到了良好的止痛效果。这些药物包括皮质类固醇激素地塞米松和强的松,可以减轻周围神经水肿和压迫引起的疼痛;抗抑郁药阿米替林、多虑平、美舒郁、百忧解,用来镇痛、镇静、改善心情;抗惊厥药卡马西平、苯妥英钠,可治疗撕裂性及烧灼样痛和放化疗后疼痛;羟嗪类抗组胺药,用于镇痛、镇静、镇吐。)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
四、用药个体化。用药剂量要根据患者个体情况确定,以无痛为目的,不应对药量限制过严而导致用药不足。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
五、严密观察患者用药后的变化,及时处理各类药物的副作用,观察评定药物疗效,及时调整药物剂量。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★远期生活质量评估(Karnofsky Performance Scale:&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
评分 描述 100 正常,无任何病症 90 可以正常活动,仅有轻微的病症 80 可以正常活动,但略感吃力 70 生活可以自理,但不能正常工作 60 偶尔需要帮助,但生活大部分能够自理 50 经常需要帮助和护理 40 绝大部分日常生活需要帮助和护理 30 卧床不起,需住院治疗,但无生命危险 20 病情严重,必须住院治疗 10 病情危重,随时有生命危险 0 死亡 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★改良Macnab疗效评定标准&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
优:症状完全消失,恢复原来的工作和生活;&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
良:有轻微症状,活动轻度受限,对工作生活无影响;&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
可:症状减轻,活动受限,影响正常工作和生活;&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
差:治疗前后无差别,甚至加重。&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★【Modified Mallampati Score】(改良马氏评分)&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
分类 描述可看到的咽喉构造 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
I 看到悬雍垂、咽喉、劈雳柱、软腭(uvula, fauces, pillars, soft palate &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
II 只看到悬雍垂、咽喉、软腭(uvula, fauces, soft palate &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
III 只看到悬雍垂根部、软腭(uvula基部, soft palate &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
IV 连软腭(soft palate)都看不到 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
★术后苏醒评估项目(Post Operative Recovery) 【原文名称:POR复苏计分系统】&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
【四肢活动度】&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
自发性或命令可活动四肢&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
自发性或命令可活动两肢&#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
四肢都不会动 &#8249;'D>&ETH;!&Oacute;&Eacute;KJbbs.zjmzzk.com K ±&Icirc;&brvbar;h&Ouml;4&Iacute;
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