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  • If you've had surgery,

    假如你曾接受手術

  • you might remember starting to count backwards from ten,

    你可能還記得從十開始倒數

  • nine,

  • eight,

  • and then waking up with the surgery already over before you even got to five.

    在你甚至數到五之前 你已經完成手術而甦醒了

  • And it might seem like you were asleep, but you weren't.

    你可能覺得你睡著了 但不是這樣的

  • You were under anesthesia,

    你被麻醉了

  • which is much more complicated.

    這比 '睡著' 複雜多了

  • You were unconscious,

    你失去意識

  • but you also couldn't move,

    而且無法動彈

  • form memories,

    無法產生記憶

  • or, hopefully, feel pain.

    或,但願,不會感到疼痛

  • Without being able to block all those processes at once,

    如果無法同時阻斷那些過程

  • many surgeries would be way too traumatic to perform.

    許多手術可能會因 身心創傷太大而無法執行

  • Ancient medical texts from Egypt, Asia and the Middle East

    來自埃及、亞洲及中東 古老的醫學文稿

  • all describe early anesthetics

    都有描述早期的麻醉藥

  • containing things like opium poppy,

    含有像罌粟、

  • mandrake fruit,

    曼德拉草果實、

  • and alcohol.

    及酒精的成分

  • Today, anesthesiologists often combine

    現今,麻醉師常結合

  • regional, inhalational and intravenous agents

    局部、吸入性及靜脈注射藥物

  • to get the right balance for a surgery.

    以獲得手術需要的正確組合

  • Regional anesthesia blocks pain signals from a specific part of the body

    局部麻醉阻斷 身體特定部位的疼痛訊號

  • from getting to the brain.

    傳遞至腦部

  • Pain and other messages travel through the nervous system as electrical impulses.

    疼痛及其他訊息 以電子脈衝運行於神經系統

  • Regional anesthetics work by setting up an electrical barricade.

    局部麻醉劑是藉著 設立電流屏障而產生作用

  • They bind to the proteins in neurons' cell membranes

    它們與神經元細胞膜的蛋白質結合

  • that let charged particles in and out,

    而使得帶電粒子能流進與流出

  • and lock out positively charged particles.

    並將帶正電粒子阻擋於細胞外

  • One compound that does this is cocaine,

    Cocaine/古柯鹼 就是 執行這種機轉的一種化合物

  • whose painkilling effects were discovered by accident

    其止痛作用是一位眼科實習醫師

  • when an ophthalmology intern got some on his tongue.

    舌頭沾到一些,而意外發現的

  • It's still occasionally used as an anesthetic,

    至今它仍偶爾用作麻醉劑

  • but many of the more common regional anesthetics

    但現在有許多更常用的局部麻醉藥

  • have a similar chemical structure and work the same way.

    具有相似的化學結構與作用機轉

  • But for major surgeries where you need to be unconscious,

    但對於病人需要 昏迷無知覺的重大手術

  • you'll want something that acts on the entire nervous system,

    將需要能作用於整個神經系統

  • including the brain.

    - 包括大腦 - 的藥物

  • That's what inhalational anesthetics do.

    吸入性麻醉劑就有這樣的作用

  • In Western medicine, diethyl ether was the first common one.

    在西方醫學 diethyl ether/乙醚 就是最早普遍使用的一種

  • It was best known as a recreational drug

    過去它以娛樂性藥物而聞名

  • until doctors started to realize that people sometimes didn't notice

    直到醫師們開始瞭解 人們有時沒注意到

  • injuries they received under the influence.

    他們是在乙醚的影響下而傷害

  • In the 1840s, they started sedating patients with ether

    在 1840 年代,醫師開始用乙醚

  • during dental extractions and surgeries.

    來鎮靜拔牙及手術的病患

  • Nitrous oxide became popular in the decades that followed

    在其後數十年,Nitrous oxide/ 一氧化二氮(笑氣)變得普遍

  • and is still used today.

    至今仍使用中

  • although ether derivatives, like sevoflurane, are more common.

    然而乙醚的衍生物 如 sevoflurane/七氟醚 更為常用

  • Inhalational anesthesia is usually supplemented with intravenous anesthesia,

    吸入性麻醉常會 額外加用靜脈注射麻醉

  • which was developed in the 1870s.

    後者是在 1870 年代研發出來

  • Common intravenous agents include sedatives, like propofol,

    常用的靜脈注射麻醉劑 包括鎮靜劑,如 propofol/異丙芬

  • which induce unconsciousness,

    可導致昏迷無意識狀態

  • and opioids, like fentanyl, which reduce pain.

    以及鴉片類 如 fentanyl/芬太尼 可減輕疼痛

  • These general anesthetics also seem to work

    這些全身麻醉劑也似乎是

  • by affecting electrical signals in the nervous system.

    藉著影響神經系統 的電子訊號發生作用

  • Normally, the brain's electrical signals are a chaotic chorus

    通常,當大腦不同部位 之間互相交流時

  • as different parts of the brain communicate with each other.

    大腦的電子訊號 就像一個失序的合唱團

  • That connectivity keeps you awake and aware.

    這種連結方式讓你 保持清醒、有知覺

  • But as someone becomes anesthetized,

    但是一旦被麻醉

  • those signals become calmer and more organized,

    那些訊號就變得較平靜、較有秩序

  • suggesting that different parts of the brain

    意謂大腦不同部份之間

  • aren't talking to each other anymore.

    不再彼此溝通

  • There's a lot we still don't know about exactly how this happens.

    這倒底是如何發生的 我們仍有許多地方不清楚

  • Several common anesthetics bind to the GABA-A receptor in the brain's neurons.

    許多常用的麻醉劑會與 大腦神經元的 GABA-A 受體結合

  • They hold the gateway open,

    它們維持通道開放

  • letting negatively charged particles flow into the cell.

    讓帶負電的粒子流入細胞內

  • Negative charge builds up and acts like a log jam,

    負電堆積就好像原木堵塞

  • keeping the neuron from transmitting electrical signals.

    阻斷神經元電子訊號傳送

  • The nervous system has lots of these gated channels,

    神經系統有許多這種門控通道

  • controlling pathways for movement,

    用來控制運動、

  • memory,

    記憶、

  • and consciousness.

    及意識的路徑

  • Most anesthetics probably act on more than one,

    大多數的麻醉劑可能不只一種作用

  • and they don't act on just the nervous system.

    而且不只作用在神經系統而已

  • Many anesthetics also affect the heart,

    許多麻醉劑也會影響心臟、

  • lungs,

    肺臟、

  • and other vital organs.

    及其他重要器官

  • Just like early anesthetics,

    就如早期的麻醉劑

  • which included familiar poisons like hemlock and aconite,

    包括熟悉的毒物,如鐵杉與烏頭

  • modern drugs can have serious side effects.

    以及現代的麻醉劑也有嚴重的副作用

  • So an anesthesiologist has to mix just the right balance of drugs

    所以麻醉師必須以 最恰當的比例混合藥物

  • to create all the features of anesthesia,

    以產生麻醉的所有作用

  • while carefully monitoring the patient's vital signs,

    同時小心地監測病人的生命徵候

  • and adjusting the drug mixture as needed.

    及視需要調整混合的藥物

  • Anesthesia is complicated,

    麻醉是複雜的

  • but figuring out how to use it

    但了解如何使用它

  • allowed for the development of new and better surgical techniques.

    讓新的及更好的外科技術得以發展

  • Surgeons could learn how to routinely and safely perform C-sections,

    外科醫師能學會如何 例行且安全地執行剖腹產手術、

  • reopen blocked arteries,

    打通阻塞的動脈、

  • replace damaged livers and kidneys,

    置換損傷的肝臟及腎臟

  • and many other life-saving operations.

    以及許多其他挽救生命的手術

  • And each year, new anesthesia techniques are developed

    每一年,新的麻醉技術都在進步

  • that will ensure more and more patients survive the trauma of surgery.

    這將確保更多病人 會熬過手術的身心創傷

If you've had surgery,

假如你曾接受手術

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B1 中級 中文 美國腔 TED-Ed 手術 作用 訊號 藥物 醫師

【TED-Ed】麻醉藥是怎麼作用的? (How does anesthesia work? - Steven Zheng)

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    Ann 發佈於 2016 年 01 月 03 日
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