玉树地震现场医疗应急救援中麻醉处理问题及对策
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摘要
目的探讨高原地震医疗救援现场麻醉处理的特点及方法。方法回顾性分析玉树地震现场444例伤员的麻醉方法、麻醉用药、麻醉效果,以及抗休克、重症监护治疗、心肺复苏等情况。在麻醉下实施手术207例,心肺复苏21例,抗休克、重症监护及疼痛治疗216例,伤员均伴有不同程度的失血性休克及挤压综合征。无常规监测和供氧,仅通过肉眼观察伤员的呼吸、口唇颜色及触摸动脉搏动,应用腕式血压计及掌式氧饱和度仪分别监测血压及氧饱和度。结果采用局部浸润麻醉、神经阻滞麻醉、非气管插管静脉麻醉+局部浸润麻醉实施手术的207例伤员均可达到理想的麻醉效果,无1例发生严重麻醉意外。7例3～6岁患儿在氯胺酮静脉麻醉+局部浸润麻醉下行清创缝合术,其中4例在苏醒时出现不同程度的精神症状。结论高原地震现场的麻醉方法选择和麻醉管理,应首选区域神经阻滞麻醉。此外,可采用咪达唑仑和少量芬太尼等无需气管插管的全身麻醉+局部浸润麻醉的方法。配备口咽通气道、简易呼吸囊等简易的辅助通气工具以保持有效通气,防止并及时纠正低血压、补充血容量,维持麻醉平稳并进行妥善的呼吸管理,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 features and methods of anesthesia during medical emergency rescue for plateau earthquake.Methods A retrospective analysis was conducted in 444 wounded people in Yushu earthquake,including the way of anesthesia,drugs for anesthesia,anesthesia outcome,anti-shock and intensive care treatment,and cardiopulmonary resuscitation.Surgical treatment was applied in 207 cases,cardiopulmonary resuscitation in 21 cases,and anti-shock,intensive care and pain therapy in 216 cases.There were different degrees of hemorrhagic shock and crush syndrome in the wounded.Regular monitoring and oxygen supply were not used in the emergency rescue.The diagnosis was based on the breath,lip color and pulses of the wounded.Blood pressure and saturation of blood oxygen were measured by wrist haemomanometer and palm oxygen saturation meter,respectively.Results Local infiltration anesthesia,nerve blocking anesthesia,or intravenous anesthesia without intubation plus local infiltration anesthesia were applied in 207 wounded people.The outcomes of anesthesia were satisfactory,and there were no severe anesthetic accidents.Ketamine and local infiltration anesthesia was used in 7 children aged from 3 to 6 years old for debridement and suturing.Mental symptoms appeared in 4 of the 7 children during recovery period.Conclusion Local nerve blocking anesthesia should be the first choice at medical emergency rescue for plateau earthquake.General anesthesia with midazolam and a small amount of sufentanil combined with local infiltration anesthesia can be also used.Oropharyngeal ventilation way and simple assisted ventilation tools,for example,simple breathing bag,should be prepared to maintain effective ventilation.Additional measures,including preventing and correcting hypotension,supplying blood volume,maintaining stable anesthesia and proper breathing management,can not only contribute to the quick operation but also meet the of anesthesia needs of emergency operation at earthquake area.
Objective To explore the features and methods of anesthesia during medical emergency rescue for plateau earthquake.Methods A retrospective analysis was conducted in 444 wounded people in Yushu earthquake,including the way of anesthesia,drugs for anesthesia,anesthesia outcome,anti-shock and intensive care treatment,and cardiopulmonary resuscitation.Surgical treatment was applied in 207 cases,cardiopulmonary resuscitation in 21 cases,and anti-shock,intensive care and pain therapy in 216 cases.There were different degrees of hemorrhagic shock and crush syndrome in the wounded.Regular monitoring and oxygen supply were not used in the emergency rescue.The diagnosis was based on the breath,lip color and pulses of the wounded.Blood pressure and saturation of blood oxygen were measured by wrist haemomanometer and palm oxygen saturation meter,respectively.Results Local infiltration anesthesia,nerve blocking anesthesia,or intravenous anesthesia without intubation plus local infiltration anesthesia were applied in 207 wounded people.The outcomes of anesthesia were satisfactory,and there were no severe anesthetic accidents.Ketamine and local infiltration anesthesia was used in 7 children aged from 3 to 6 years old for debridement and suturing.Mental symptoms appeared in 4 of the 7 children during recovery period.Conclusion Local nerve blocking anesthesia should be the first choice at medical emergency rescue for plateau earthquake.General anesthesia with midazolam and a small amount of sufentanil combined with local infiltration anesthesia can be also used.Oropharyngeal ventilation way and simple assisted ventilation tools,for example,simple breathing bag,should be prepared to maintain effective ventilation.Additional measures,including preventing and correcting hypotension,supplying blood volume,maintaining stable anesthesia and proper breathing management,can not only contribute to the quick operation but also meet the of anesthesia needs of emergency operation at earthquake area.
引文
1 MATHEW J P.Randomized,double blinded placebo controlled study of neuroprotection with lidocaine in cardiac surgery.Stroke,2009,40(3):880-887.
2 WEDMORE I S,JOHNSON T,CZARNIK J,et al.Pain management in the wilderness and operational setting[J]. Emerg Med Clin North Am,2005.23(2):585-601,Ⅺ-Ⅻ.
3徐家相.地震灾害的紧急医疗救援[J].中华急诊医学杂志, 2005,14(7):557-558.
2 WEDMORE I S,JOHNSON T,CZARNIK J,et al.Pain management in the wilderness and operational setting[J]. Emerg Med Clin North Am,2005.23(2):585-601,Ⅺ-Ⅻ.
3徐家相.地震灾害的紧急医疗救援[J].中华急诊医学杂志, 2005,14(7):557-558.
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