汶川地震灾区伤员现场救治的麻醉学管理
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摘要
目的探讨地震灾区伤员现场救治的麻醉学管理的特点。方法回顾性分析在汶川县映秀镇现场救治136例伤员的麻醉学管理。依据伤类与伤势,对伤员分别实施呼吸维护、液体复苏、手术麻醉、疼痛治疗等处理。结果清理呼吸道分泌物或异物15例(11.0%),液体复苏82例(60.2%),手术麻醉75例(55.1%),镇痛治疗23例(16.9%)。全组无死亡病例,未出现麻醉相关的并发症。除轻伤员外,其余伤员全部乘直升机安全后送。结论地震灾区现场紧急救治是伤员获救的基本保证,科学救治、规范施治是减少死亡率和致残率的重要环节。对于麻醉学而言,尤其要强调加强呼吸管理、及时有效的休克复苏、合理选择麻醉方式、严密监测调控生命体征和良好的镇痛治疗。
Objective To summerize the characteristics of anesthetic management for traumatic patients in the field during Wenchuan earthquake.Methods The data of 163 traumatic cases in the earthquake disaster zone of Yingxiu Town of Wenchuan County were retrospectively analyzed.The victims were given in time the respiratory support,fluid resuscitation,pain management and anaesthesia and operation on the bases of the category and severity of wound.Results Removal of foreign bodies or secretion of respiratory tract was performed in 15(11.0%) cases,fluid resuscitation in 82(60.2%) cases,surgery under anaesthesia in 75(55.1%) cases,and pain management in 23(16.9%) cases.There were no complications associated with anaesthesia and no death cases.All victims were evacuated safely by helicopter excepted lightly wounded.Conclusion The first aid on the spot of earthquake disaster zone is the basic guarantee for the successful treatment of the victims.The correct treatment was the key link to reduce mortality and mutilation rate.In terms of anaesthesia,particular attention should be paid to the appropriate respiratory support,effective correction of shock,smooth anesthesia,ideal pain management,comprehensive monitoring and regulation of vital signs.
Objective To summerize the characteristics of anesthetic management for traumatic patients in the field during Wenchuan earthquake.Methods The data of 163 traumatic cases in the earthquake disaster zone of Yingxiu Town of Wenchuan County were retrospectively analyzed.The victims were given in time the respiratory support,fluid resuscitation,pain management and anaesthesia and operation on the bases of the category and severity of wound.Results Removal of foreign bodies or secretion of respiratory tract was performed in 15(11.0%) cases,fluid resuscitation in 82(60.2%) cases,surgery under anaesthesia in 75(55.1%) cases,and pain management in 23(16.9%) cases.There were no complications associated with anaesthesia and no death cases.All victims were evacuated safely by helicopter excepted lightly wounded.Conclusion The first aid on the spot of earthquake disaster zone is the basic guarantee for the successful treatment of the victims.The correct treatment was the key link to reduce mortality and mutilation rate.In terms of anaesthesia,particular attention should be paid to the appropriate respiratory support,effective correction of shock,smooth anesthesia,ideal pain management,comprehensive monitoring and regulation of vital signs.
引文
[1]Haq MA,Khan A,Rao ZA.Anesthetic management of earth-quake victi ms.Anesth Pain Intens Care,2006,10:18-21.
[2]Ashkenazi I,Isakovich B,Kluger Y,et al.Prehospital man-agement of earthquake casualties buried under rubble.Pre-hosp Disaster Med,2005,20:122-133.
[3]Gunal AI,Celiker H,Dogukan A,et al.Early and vigorous fluid resuscitation prevents acute renal failure in the crush victi ms of catastrophic earthquakes.J AmSoc Nephrol,2004,15:1862-1867.
[4]Talving P,Palstedt J,Riddez L.Prehospital management and fluid resuscitationin hypotensive trauma patients admitted to Karolinska University Hospital in Stockhol m.Prehosp Disas-ter Med,2005,20:228-234.
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[6]Janjua SK,Ahmed S,Tariq M,et al.Anesthestic management in disasters:an anesthetist`s experience in“Lamno”banda ache Indonesia.Pak Armed Forces Med J,2006,56:333-341.
[7]Mulvey J M,Qadri AA,Maqsood MA.Earthquake injuries and the use of ketamine for surgical procedures:the Kashmir experience.Anaesth Intensive Care,2006,34:489-494.
[8]Paix BR,Capps R,Neumeister G,et al.Anaesthesia in a dis-aster zone:a report on the experience of an Australian medi-cal teamin Banda Acehfollowingthe‘Boxing Day Tsunami’.Anaesth Intensive Care,2005,33:629-634.
[9]Grande CM,Baskett PJ,Donchin Y,et al.Trauma anesthesia for disasters.Anything,anyti me,anywhere.Crit Care Clin,1991,7:339-361.
[10]Baker BC,Buckenmaier C,Narine N,et al.Battlefield anes-thesia:advances in patient care and pain management.Anes-thesiol Clin,2007,25:131-145.
[2]Ashkenazi I,Isakovich B,Kluger Y,et al.Prehospital man-agement of earthquake casualties buried under rubble.Pre-hosp Disaster Med,2005,20:122-133.
[3]Gunal AI,Celiker H,Dogukan A,et al.Early and vigorous fluid resuscitation prevents acute renal failure in the crush victi ms of catastrophic earthquakes.J AmSoc Nephrol,2004,15:1862-1867.
[4]Talving P,Palstedt J,Riddez L.Prehospital management and fluid resuscitationin hypotensive trauma patients admitted to Karolinska University Hospital in Stockhol m.Prehosp Disas-ter Med,2005,20:228-234.
[5]Fowler R,Pepe PE.Fluid resuscitation of the patient with major trauma.Curr Opin Anaesthesiol,2002,15:173-178.
[6]Janjua SK,Ahmed S,Tariq M,et al.Anesthestic management in disasters:an anesthetist`s experience in“Lamno”banda ache Indonesia.Pak Armed Forces Med J,2006,56:333-341.
[7]Mulvey J M,Qadri AA,Maqsood MA.Earthquake injuries and the use of ketamine for surgical procedures:the Kashmir experience.Anaesth Intensive Care,2006,34:489-494.
[8]Paix BR,Capps R,Neumeister G,et al.Anaesthesia in a dis-aster zone:a report on the experience of an Australian medi-cal teamin Banda Acehfollowingthe‘Boxing Day Tsunami’.Anaesth Intensive Care,2005,33:629-634.
[9]Grande CM,Baskett PJ,Donchin Y,et al.Trauma anesthesia for disasters.Anything,anyti me,anywhere.Crit Care Clin,1991,7:339-361.
[10]Baker BC,Buckenmaier C,Narine N,et al.Battlefield anes-thesia:advances in patient care and pain management.Anes-thesiol Clin,2007,25:131-145.
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