严重创伤病人的麻醉（PPTX页）.ppt

严重创伤病人的麻醉 Anesthesia for Trauma In advanced countries, injury ranks as the fourth leading cause of death following heart disease, cancer, and cerebrovascular disease. Preoperative Assessment Penetrating trauma injures as the energy behind the penetrating instrument causes stretching and crushing of tissues. The energy dissipation profiles of different weapons（Knives and bullets determine the anatomic depth and extent of maximum injury. In the second peak, exsanguinations from vascular injuries causes death within a few hours without medical treatment. Inadequate or delayed shock resuscitation or surgical treatment leads to late death from infection, sepsis, or multiorgan failure. B. Breathing（give supplemental oxygen） 1. Determine whether ventilation is adequate 2. Inspect chest to exclude open pneumothorax, sucking chest wound, or flail segment 3. Ausculate for bilateral breath sounds 4. Provide assisted ventilation for ventilatory failure D. Disability（determine neurologic status） 1. Evaluate central function A：alert V：responds to vocal stimulus P：responds to painful stimulus U：Unresponsive 2. Evaluate pupil response to light E：Expose patient for complete examination Ⅲ. Resuscitation phase Ⅳ. Secondary surrey Ⅴ. Definitive care phase （2）某些情况下行紧急气管内插管 （3）喉罩（LMA）可用于快速建立通 气途径 （4）纤支镜的应用 （5）气管造口术 ● 对输入液体的选择：首先是恢复血容量，其次 考虑必需的血红蛋白浓度，最后是保持凝血机 制正常或基本正常。应注意晶、胶体比例，血 液的合理应用，必要时辅用血管活性药物。 ● 75%氯化钠与胶体液的混合液的应用。 4．应注意纠正酸碱平衡和电解质方面的紊乱。 5．其他 如适当止痛，进行必要的监测等。 麻醉处理要点 一、必须充分认识此类病人的麻醉特点 1．严重创伤病人不能耐受深的全身麻醉，也 不能耐受其麻醉平面或范围可对病人的血流动力学 造成明显影响的椎管内麻醉。 2．凡经肝代谢、经肾排泄的麻醉用药其作用 时间明显延长。 3．应一律按“饱胃”病人处理。 4．了解其麻醉前复苏情况，以便进一步处理。 5．往往难于合作或已昏迷。 2．麻醉选择 （1）全身麻醉：多处伤或其他严重创伤、气管内插 管应避免采用在某些情况下不宜采 用的药物： ● 氯胺酮 ● 琥珀胆碱 ● 氧化亚氮 ● 安氟