严重创伤病人的麻醉1要点.ppt

严重创伤病人的麻醉 Anaesthesia for Critical Trauma Patients 几个概念 创伤 多发伤 多部位伤 复合伤 Why should we learn trauma anesthesia? Anesthesiologists are being faced with anesthetizing an increasing number of trauma patient All anesthesiologists will likely have significant and unpredictable exposure to trauma patients In 1993, approximately 90,000 individuals in the U.S died of accidental injuries , for a rate of 34.9 deaths per 100, 000 population, the second lowest accidental death rate on record In the same year there were an estimated 18,200,000 disabling accidental injuries, or about 2,080 injuries every hour, and the 90,000 accidental deaths amounted to 1 every 6 minutes---and these numbers excluded the rising level of intentional injuries caused by attempted or successful suicides and homicides Injury ranks as the fourth leading cause of death in the U.S. Currently, for American younger than 40 years, trauma is the most common cause of death, following heart disease, cancer, and cerebrovascular disease Potential roles of the anesthesiologist in this area Trauma team member Trauma team leader Anesthesiologist Critical care physician 病情评估 病情评估 评分系统（scoring system) 创伤机制 (mechanisms of injury) Scoring system ASAPS GCS: a useful prognostic tool for patient with acute head injuries TS, RTS(revised trauma score) and PTS(pediatric trauma score): used to predict outcome and direct patients to appropriate facilities. CRAMS Score ASA分级 GCS（Glasgow coma score) Eye opening (4~1) Verbal responses (5~1) Motor responses (6~1) Eye opening Spontaneous-------------------- 4 To voice------------------------ 3 To pain------------------------- 2 To none------------------------ 1 Verbal reponses Oriented--------------------- -- 5 Confused----------------------- 4 Inappropriate------------------ 3 Incomprehensive words------ 2 None---------------------------- 1 Motor response Obeys command-------------------- 6 Localizes pain----------------------- 5 Withdraws(pain)-------------------- 4 F