382例严重地震伤员救治的麻醉处理

Anesthesia management of 382 cases with severe trauma in earthquake

目的总结地震伤员手术治疗的急救及麻醉处理体会。方法382例年龄2～91岁严重地震伤进行492台次手术;针对不同病情、年龄、手术方式等采用气管插管静-吸复合全麻、氯胺酮静脉复合麻醉、硬膜外阻滞、蛛网膜下腔阻滞及神经阻滞等麻醉方式,并分析了休克、挤压伤综合征、急性肾功能衰竭等地震危急伤情的术前准备、术中处理及监测。结果术中血流动力学基本稳定,SpO2维持在92%～100%;治愈356例,好转23例,死亡3例。结论术前积极的扩容抗休克、维护肾脏功能,加强术中监测、及时纠正水电解质和酸碱平衡紊乱,维持血流动力学稳定等是地震伤员安全渡过围术期的关键。

Objective To summarize the anesthesia managements and the first aid treatment on severe traumatic patients in earthquake. Methods A total of 382 cases aged 2-92 years old underwent 492 operations under general anesthesia, epidural block, subarachnoid block, nerve block or ketamine intravenous anesthesia according to different conditions. Preoperative preparation, antishock and anesthesia managements were analyzed. Crush syndrome and acute renal failure were treated. Results The hemodynamics were stabilized and SpO2 was kept in 92%-100% during operation. The patients were clinic cured in 356 cases,improved in 23 cases and died in 3 patients. Conclusion The keys for anesthesia managements of the severe earthquake traumatic patients are sufficient preoperative volume treatment, positive anti-shock therapy, protection of renal function, correction of electrolytes and acidbase disorders and maitenance of hemodynamic stability.