地震后重症伤员紧急抢救手术的麻醉探讨

Anesthetic experiences of emergency surgical operation of severe traumatic patients in earthquake

目的探讨地震后重伤员一线医院抢救手术的麻醉与休克复苏。方法总结汶川特大地震后首日(17h)收治的48例,危重伤员的麻醉前急救复苏及麻醉处理;浅析了野战手术室的组建及休克的容量复苏;根据手术部位及病情等选用全麻、硬膜外阻滞及氯胺酮静脉复合麻醉;强调术中监测的重要性。结果13例失血性休克患者术中SBP、MBP明显回升,HR逐渐下降至正常水平,与麻醉前对照P<0.01;33例复合伤麻醉平稳,术中BP、HR及SpO2稳定。术中死亡2例,主要死亡原因为特重型颅脑外伤1例、严重的创伤性失血性休克1例。结论地震后重危伤员的一线抢救重在及时,早期容量治疗是麻醉平稳的基础,合理选择麻醉方式,加强术中监测处理可提高抢救成功率。

Objective To discuss the anesthesia and resuscitation of emergency treatment of severe traumatic patients in earthquake. Methods 17 hours after Wenchuan earthquake, anesthesia management and resuscitation of emergency treatment for severe traumatic patients were reviewed. The establishment of field operating room and volume therapy of the hemorrhagic shock were discussed. In these cases, general anesthesia, epidural block and ketamine intravenous anesthesia were used. Results HR decreased to normal level and SBP, MBP was higher in 13 cases of hemorrhagic shock during the operation （P〈0.01）. In 33 cases of multiple trauma, BP, HR and SpO2 were stable. 2 cases of patient died in the operation. The reasons were severe head injury （1 case）and severe traumatic hemorrhagic shock （1 case）. Conclusions The key of severe trauma treatment is quick and immediate. Earlier volume therapy is the basis of anesthesia stability. Reasonable anesthetic methods and the monitoring may raise the success rate of resuscitation.