局麻中的医疗过失原因与对策

Causes and countermeasures of local anesthesia accidents

总结自１９８５年以来，本院及外院手术局麻中医疗过失９例。其中麻醉药品管理不当造成者３例；麻醉技术原因３例；麻醉药过量２例；麻醉药注射部位不当１例。以上原因造成患者死亡１例，功能障碍３个月以上者２例。医疗过失的主要原因是麻醉药品管理不当和医务人员专业知识不牢，技术不熟。加强医院的管理制度，提高医务人员的业务素质，是防范局麻过失的主要措施。对局麻药的全身性不良反应进行了讨论，认为高浓度是造成不良反应的主要因素。当利多卡因血内浓度达５０～１００μｇ／ｍｌ时，可出现剂量相关性淋巴细胞转化的抑制。血内局麻药的浓度骤然升高，可引起一系列的毒性症状，甚至全身性强直阵挛性惊厥和死亡。

The authors presented 9 cases of local anesthesia accidents occurred in our and another hospital since 1985. The causes of the accidents included: careless management in 3 cases, error of anesthetic technic in 3 cases, anesthetic overdose in 2 cases,and incorrect injection place in 1 case. The results of the accidents consisted of 1 death and 2 cases dysfunction. The authors considered the systemic side effects were caused by too high concentration of local anesthetic in blood. when the concentration of lidocaine in blood reached steeply at 50-100μg/ml, thebioche mical transformation of lymphocyite is dose-dependently inhibited. As the local anesthetic concentration rises in blood, the systemic toxic symptoms appear, such as convulsion and death On the contrary, when the low concentration lidocaine of less than 0.1% is administered, no accidents occured even though the total dosage reached 80mg/kg during liposunction under tumescent anaesthesia. As the primary causes of the accidents attribute to careless management, inappropriate administration of local anesthesia and shortage of professional knowledge and experiences, the enhancement of administrative regulations and intensification of medical staffs'trainning on professional knowledge techniques and responsibility are emphasized.