骨科地震伤员手术的麻醉处理体会
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摘要
目的:探讨骨科地震伤员手术的麻醉方法,体会其麻醉处理的特殊性。方法:回顾我院抗震救灾应急分院接受的骨科地震伤员手术麻醉84例,男53例,女31例,年龄6岁~92岁,ASAⅠ级~Ⅲ级,行脊柱骨折切开复位内固定术16例、上肢骨骨折切开复位内固定术17例、下肢骨骨折切开复位内固定术42例、感染伤口清创术9例。术前30min肌肉注射阿托品0.5mg、苯巴比妥钠0.1g,全部采用全麻插管静脉复合麻醉。麻醉诱导按镇静、镇痛、肌松原则给药,麻醉维持采用静脉复合麻醉。术中行常规生命体征监测,手术开始前输注晶体液15ml/kg~20ml/kg,术中注意维护血流动力学稳定,使MAP维持在65mmHg~80mmHg,必要时输注血液制品。术毕酌情拔除气管导管送伤员回病房或带管转入ICU。术后行静脉自控镇痛(PCIA)。结果:84例患者均顺利完成手术,术中生命体征平稳,无严重并发症发生,术后PCIA效果良好。结论:骨科地震伤员手术采用全麻插管静脉复合麻醉是安全合理的,PCIA减轻了伤员痛苦,避免进一步的心理损害。
Objective To research anesthesia method of orthopedic surgery of earthquake wounded to understand the anesthesia particularity. Methods Recalling 84 anesthesia cases of orthopedic earthquake wounded in resistance-earthquake-treatment-victim emergency hospital of Suining. There were 53 mlaes and 31 femlaes,whose age from 6 to 92, whose ASA from Ⅰto Ⅲ . There were 16 cases performed with spinal fractures open reduction and internal fixation. There were 17 cases performed with upper limbs fracture open reduction and internal fixation. There were 42 cases performed with lower limbs fracture open reduction and internal fixation. There were 9 cases of debridement of wound infection. All cases were injected with 0.5 mg of atropine and 0.1 g of Phenobarbital 30 minutes before operation and Used general anesthesia intubation intravenous anesthesia. We have inducted anesthesia in accordance with sedation, analgesia, and muscle relaxation principle;and maintented anesthesia by intravenous method. We have monitored routine vital signs during operation. Infusion of liquid crystal 15 ml/kg～20 ml/kg before operation and maintaining stable hemodynamics during operation, Maintaining MAP at 65~80 mmHg, When necessary infusion of blood products. The end of operation, as appropriate, tracheal tube and removed the wounded sent back to the wards or bring into the ICU. PCIA after operation .Results 84 cases have been successful finished operation, and maintained vital signs during operation,no serious complications , PCIA good effect after operation.Conclusion The orthopedic earthquake wounded have been used the general anesthesia intubation intravenous anesthesia was reasonable safety,PCIA reduce the suffering of the wounded to avoid further psychological damage.
Objective To research anesthesia method of orthopedic surgery of earthquake wounded to understand the anesthesia particularity. Methods Recalling 84 anesthesia cases of orthopedic earthquake wounded in resistance-earthquake-treatment-victim emergency hospital of Suining. There were 53 mlaes and 31 femlaes,whose age from 6 to 92, whose ASA from Ⅰto Ⅲ . There were 16 cases performed with spinal fractures open reduction and internal fixation. There were 17 cases performed with upper limbs fracture open reduction and internal fixation. There were 42 cases performed with lower limbs fracture open reduction and internal fixation. There were 9 cases of debridement of wound infection. All cases were injected with 0.5 mg of atropine and 0.1 g of Phenobarbital 30 minutes before operation and Used general anesthesia intubation intravenous anesthesia. We have inducted anesthesia in accordance with sedation, analgesia, and muscle relaxation principle;and maintented anesthesia by intravenous method. We have monitored routine vital signs during operation. Infusion of liquid crystal 15 ml/kg～20 ml/kg before operation and maintaining stable hemodynamics during operation, Maintaining MAP at 65~80 mmHg, When necessary infusion of blood products. The end of operation, as appropriate, tracheal tube and removed the wounded sent back to the wards or bring into the ICU. PCIA after operation .Results 84 cases have been successful finished operation, and maintained vital signs during operation,no serious complications , PCIA good effect after operation.Conclusion The orthopedic earthquake wounded have been used the general anesthesia intubation intravenous anesthesia was reasonable safety,PCIA reduce the suffering of the wounded to avoid further psychological damage.
引文
[1]董慧娟,顾建华.印度洋地震海啸中国大陆受害者心理状况调查与分析[J].中国综合临床,2007,23(2):147.
[2]庄心良,曾因民,陈伯銮.现代麻醉学[M].第3版.北京:人民卫生出版社,2003,500:533.
[3]唐甫斌,浦金辉.地震伤员的处理原则[J].创伤外科杂志,2007,9(3):210.
[2]庄心良,曾因民,陈伯銮.现代麻醉学[M].第3版.北京:人民卫生出版社,2003,500:533.
[3]唐甫斌,浦金辉.地震伤员的处理原则[J].创伤外科杂志,2007,9(3):210.
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