地震灾区伤病员现场急救手术的麻醉处理
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摘要
目的探讨地震现场急救手术麻醉处理的特点和方法。方法回顾性分析了52例患者现场手术的麻醉,其中局部浸润麻醉12例、神经阻滞麻醉18例、硬膜外麻醉5例、蛛网膜下腔麻醉1例、非气管插管静脉麻醉15例、气管插管加静脉麻醉1例,采用腕式血压计和掌式氧饱和度仪分别监测血压和氧饱和度。结果1例患者出现心脏停跳,1例硬膜外麻醉穿破了硬脊膜,其余患者麻醉完善、手术顺利。结论在灾区现场进行麻醉,首选除硬膜外麻醉和蛛网膜下腔麻醉外的区域神经阻滞麻醉,还可以采用咪唑安定、氯胺酮和少量芬太尼进行无需气管插管的全身麻醉,同时配备口咽通气道、喉罩和简易呼吸囊等简易的辅助通气工具。这样既能保证手术快速进行,又能满足灾区现场急救手术的麻醉需要。
Objective To explore the methods and characteristic of anesthetic management in earthquake disaster area.Methods The data of anesthesia were respectively analyzed in 52 cases including 12 cases of local infiltration anesthesia,18 cases of nerve blocking anesthesia,5 cases of epidural anesthesia,1 cases of spinal anesthesia,15 cases of intravenous anesthesia without tracheal intubation and 1 case of intravenous anesthesia with tracheal intubation.The vital signs were monitored by wrist hemomanometer and fingertip pulse Oximeter.Results One patient suffered from cardiac arrest,one case was punctured dura mate of spinal cord during epidural anesthesia,the others were safe during anesthesia.Conclusion Regional nerve blocking anesthesia except epidural anesthesia and spinal anesthesia may be preferred in earthquake disaster are.Some surgery should be operated under general anaesthesia with midazolam,ketamine and small dose fentanyl without tracheal intubation,at the same time,oropharyngeal and nasopharyngeal airways,laryngeal mask,facility breathing bag would be on standby,so not only guarantee the surgery be carried out smoothly and betimes but also sufficed the requirement of field first aid anesthesia in earthquake disaster area.
Objective To explore the methods and characteristic of anesthetic management in earthquake disaster area.Methods The data of anesthesia were respectively analyzed in 52 cases including 12 cases of local infiltration anesthesia,18 cases of nerve blocking anesthesia,5 cases of epidural anesthesia,1 cases of spinal anesthesia,15 cases of intravenous anesthesia without tracheal intubation and 1 case of intravenous anesthesia with tracheal intubation.The vital signs were monitored by wrist hemomanometer and fingertip pulse Oximeter.Results One patient suffered from cardiac arrest,one case was punctured dura mate of spinal cord during epidural anesthesia,the others were safe during anesthesia.Conclusion Regional nerve blocking anesthesia except epidural anesthesia and spinal anesthesia may be preferred in earthquake disaster are.Some surgery should be operated under general anaesthesia with midazolam,ketamine and small dose fentanyl without tracheal intubation,at the same time,oropharyngeal and nasopharyngeal airways,laryngeal mask,facility breathing bag would be on standby,so not only guarantee the surgery be carried out smoothly and betimes but also sufficed the requirement of field first aid anesthesia in earthquake disaster area.
引文
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[2]Situation Reports:Australian Aid International PakistanEarthquake relisf[CP/DK].2005,from www.aai.org.au/pakistan.htm.
[3]Boulton TB.Anaestesia and resuscitation in difficult envi-ronment.Recent Advances in Anaesthesia and Analgesia[M].11th Ed.New York:Churchill Livingstone,1972:1.
[4]Wedmore IS,Johnson T,Czarnik J,et al.Pain mamage-ment in the silderness and operational setting[J].EmergMed Clin North Am,2005,23:585.
[5]Pesonen.Pulse oximetry during ketamine anaesthesia inwar conditions[J].Can J Anawsth,1991,38:592.
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