汶川地震后野外条件下111例麻醉经验总结
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摘要
背景"5.12"汶川大地震后,第二军医大学长征医院医疗救护队赴四川绵阳建立野战医院,展开医疗救治工作。期间共通过伤员2715例,在麻醉下实施紧急手术111例。方法回顾分析在野战医院条件下实施的111例麻醉资料,就患者伤情、麻醉方法和围术期麻醉管理进行总结。结果在接受麻醉下手术的111例患者中,年龄最大者81岁,最小仅5个月。实施静吸复合全身麻醉19例,椎管内麻醉40例,基础麻醉41例,臂丛神经阻滞11例。所有患者均安全度过围术期,包括成功实施2例新生儿复苏,没有出现严重麻醉并发症。结论地震伤员伤情复杂,野战医院的医疗设备和资源有限,麻醉应以保证患者生命安全、减轻患者痛苦、简单有效为原则,尽量避免出现麻醉并发症。
Objective To summarize the experience in anesthesia for casualties under field condition after the 2008 Wenchuan Earthquake in China.Methods Medical records of 111 casualties who required anesthesia were retrospectively analyzed, including injury condition, anesthetic method and perioperative management. Results Among the 111 patients, the eldest one was eighty-one years, and the youngest one was five months. The types of anesthesia included general anesthesia (19 cases), intrathecal anesthesia (40 cases), basal anesthesia (41 cases) and brachial plexus block (11 cases). All the patients were safe during perioperative period, including two infants who experienced successful resuscitation. No major complications occurred.Conclusion The earthquake-related injuries are complex. As the medical facilities and resources are limited in the field hospital, the principles of anesthesia should be stressed on effectiveness and simpleness in addition to guarantee of safety and reduction of pains and complications.
Objective To summarize the experience in anesthesia for casualties under field condition after the 2008 Wenchuan Earthquake in China.Methods Medical records of 111 casualties who required anesthesia were retrospectively analyzed, including injury condition, anesthetic method and perioperative management. Results Among the 111 patients, the eldest one was eighty-one years, and the youngest one was five months. The types of anesthesia included general anesthesia (19 cases), intrathecal anesthesia (40 cases), basal anesthesia (41 cases) and brachial plexus block (11 cases). All the patients were safe during perioperative period, including two infants who experienced successful resuscitation. No major complications occurred.Conclusion The earthquake-related injuries are complex. As the medical facilities and resources are limited in the field hospital, the principles of anesthesia should be stressed on effectiveness and simpleness in addition to guarantee of safety and reduction of pains and complications.
引文
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[2]Demiykiran O,Dikmen Y,Utku T,et al.Crush syndrome pa-tients after the Marmara earthquake[J].Emerg Med J,2003,20:247-250.
[3]蒋京京,刘虎,徐海涛,等.地震后挤压伤患者野外条件下的围术期麻醉管理[J].第二军医大学学报,2008,29:586-587.
[4]Mulvey JM,Qadri AA,Maqsood MA.Earthquake injuries and the use of ketamine for surgical procedures:the Kashmir expe-rience[J].Anaesth Intensive Care,2006,34:489-494.
[5]Mulvey JM,Awan SU,Qadri AA,et al.Profile of injuries ari-sing from the2005Kashmir earthquake:the first72h[J].In-jury,2008,39:554-560.
[6]Zatzick DF,Rivara FP,Nathens AB,et al.A nationwide U.S.study of post-traumatic stress after hospitalization for physi-cal injury[J].Psychol Med,2007,37:1469-1480.
[7]Wu CL,Sapirstein A,Herbert R,et al.Effect of postoperative epidural analgesia on morbidity and mortality after lung resec-tion in Medicare patients[J].J Clin Anesth,2006,18:515-520.
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