地震后挤压伤患者野外条件下的围手术期麻醉管理
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摘要
目的:总结地震所致挤压伤伤员野外条件下围手术期处理经验。方法:回顾分析我院麻醉科在五一二汶川大地震后野外救治的10例挤压伤伤员临床资料,总结围手术期麻醉管理经验。结果:经过容量治疗、碱化尿液、稳定内环境等处理后,10例伤员在硬膜外或臂丛麻醉下,辅以心理安慰和适量镇静剂,接受了清创或筋膜切开减压手术。术中伤员呼吸、循环平稳,镇痛良好。结论:野外条件下,区域麻醉可提供充分的术中及术后镇痛;早期液体复苏和生命支持有利于保障伤员生命安全。
Objective:To summarize our experience on perioperative anesthesia management of patients with crush syndrome caused by earthquake under field condition.Methods:The clinical anesthesia data of 10 patients with crush syndrome caused by China Wenchuan earthquake,who were treated under field condition,were retrospectively analyzed,and our experience on perioperative anesthesia management was summarized.Results:After volume therapy,urine alkalization,and stabilization of internal environment,the 10 patients underwent dehridement,decompression by fasciotomy or amputation under epidural anesthesia or brachial plexus block plus psychological therapy and moderate tranquillizer.During the operation,the patients showed smooth respiratory and cardiovascular characteristics without pain.Conclusion:Under field condition,regional anesthesia can provide adequate analgesic effect during and after the surgery.Early fluid resuscitation and life support are vital to the safety and life of patients.
Objective:To summarize our experience on perioperative anesthesia management of patients with crush syndrome caused by earthquake under field condition.Methods:The clinical anesthesia data of 10 patients with crush syndrome caused by China Wenchuan earthquake,who were treated under field condition,were retrospectively analyzed,and our experience on perioperative anesthesia management was summarized.Results:After volume therapy,urine alkalization,and stabilization of internal environment,the 10 patients underwent dehridement,decompression by fasciotomy or amputation under epidural anesthesia or brachial plexus block plus psychological therapy and moderate tranquillizer.During the operation,the patients showed smooth respiratory and cardiovascular characteristics without pain.Conclusion:Under field condition,regional anesthesia can provide adequate analgesic effect during and after the surgery.Early fluid resuscitation and life support are vital to the safety and life of patients.
引文
[1]Vanholder R,van der Tol A,De Smet M,Hoste E,Koc M, Hussain A,et al.Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster[J].Kidney Int, 2007,71:17-23.
[2]梁培禾，靳凤烁．挤压综合征[J]．中国医刊，2007，42；75-77．
[3]Sahjian M.Frakes M.Crush injuries:pathophysiology and current treatment[J].Nurse Pratt,2007,32:13-18.
[4]方国恩．赵为国．挤压综合征和肾功能不全[J]．中国实用外科杂志，2002，22：70-72．
[5]陈伯銮．创伤病人围术期准备和有关综合征的处理[J]．中华麻醉学杂志，2002，22：574-576．
[6]Sever M S,Vanholder R,Lameire N.Management of crush-re- lated injuries after disasters[J].N Engl J Med,2006.354:1052- 1063.
[2]梁培禾，靳凤烁．挤压综合征[J]．中国医刊，2007，42；75-77．
[3]Sahjian M.Frakes M.Crush injuries:pathophysiology and current treatment[J].Nurse Pratt,2007,32:13-18.
[4]方国恩．赵为国．挤压综合征和肾功能不全[J]．中国实用外科杂志，2002，22：70-72．
[5]陈伯銮．创伤病人围术期准备和有关综合征的处理[J]．中华麻醉学杂志，2002，22：574-576．
[6]Sever M S,Vanholder R,Lameire N.Management of crush-re- lated injuries after disasters[J].N Engl J Med,2006.354:1052- 1063.
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