21例颈椎骨折脱位截瘫患者急诊手术的麻醉处理

The Anesthetic Treatments In 21 Cases Of Cervical Fracture-Dislocation Paraplegia Emergency Operations

目的总结21例颈椎骨折脱位截瘫患者急诊手术的麻醉处理过程。方法对21例颈椎骨折脱位截瘫患方者实施一系列麻醉处理措施:①头颈部严格制动,避免颈髓继发性损伤;②建立多条静脉通路其中包括中心静脉置管、快速扩容,维持最低有效灌注压,尽可能不用或少用缩血管活性药;③麻醉诱导要求平稳,循环干扰少,又保证氧供和提高动脉血氧,同时能有效抑制有害应激反应和消除病人的精神紧张,避免应用损害或抑制心肌的药物,慎用对循环有抑制作用的麻醉药;④早期应用糖皮质激素。结果21例的手术和麻醉管理均获得成功,经术后进一步积极支持治疗后85.7%患者康复。结论对颈椎骨折脱位截瘫患者在围术期麻醉处理得当,可大大降低颈椎骨折脱位截瘫患者结的死亡率。

s Objective To summarize the anesthetic treatments in 21 cases of cervical fracture- dislocation paraplegia emergency operations. Method A series of rescue measures were carried out on these 21 cervical fracture-dislocation paraplegia patients:①Forbad the movement of head and neck, to prevent the secondary cervical spine cord injury;②Established multiple intravenous routes,including the central vein intubations, enlarged the volume rapidly, maintained the minimum valid perfusion pressure, stopped or reduced using vasoconstrictor;③The anesthetic induction should be done smoothly, with low disturbance to the circulation, help ensure the oxygen supply, increase the oxygen volume in the arterial blood, repress the hazardous stress and relieve the nervousness of the patients.So it’s better avoid using the anesthesia might injure or repress the cerebral muscle, use with care those might repress the circulation; ④ Glucocorticoids should be used at early stage. Results The rescues, operations and anesthetic treatments of these 21 patients were all successful, after further therapy, 85.7% of the patients recovered totally. Conclusion If the anesthetic treatment is proper during the perioperative period, the mortality rate of cervical fracture-dislocation paraplegia patients can be reduced dramatically.