课件：严重创伤病人的麻醉.pptVIP

严重创伤病人的麻醉,overview,In advanced countries, injury ranks as the third leading cause of death following heart disease and cancer.,Treatment principle to critically ill patients,Assessment to organ function and disease states Preoperative treatment Selection to anesthesia way and anesthetics Close intra-operative monitoring and correction to abnormality of pathophysiological state Positive prevention and treatment toPostoperative complications,Preoperative Assessment,心功能分级及意义 级 别 屏气 临 床 表 现 临床意义 麻醉 试验 I级 30s 能耐受日常体力活动 心功能正常 耐受力 活动后无心慌 良好 气短等不适 II级 2030s 日常体力活动有一定不适， 心功能较差 如处理适当 自行控制活动量， 耐受仍好 不能作跑步或用力的工作 III级 1020s 轻度或一般体力活动后 心功能不全 麻醉前应充分准备 心悸、气短明显， 应避免增加心脏负担 只能胜任极轻微的体力 活动或静息 IV级 10s以内 不能耐受任何体力活动， 心功能衰竭 极差，一般需推迟 静息时也感气短，不能平卧， 有端坐呼吸、心动过速等表现,5.5 Assess to blood loss of damage in different parts Estimation to blood loss （ml） Position Moderate damage Severe damage Upper limb 500 1000 Calf 500 2000 Thigh 1000 3500 Pelvis 1000 4000 Abdomen 1000 5000 Chest 1000 4000,Characteristics of severe trauma patients condition,1 病情紧急 注意检查和治疗的矛盾 2病情严重 失血性休克发生率可达95% 3病情复杂 复合伤居多 4疼痛剧烈 5饱胃 急诊病人一律视为饱胃病人,anesthesia characteristics of Severe trauma patients,1不能耐受深麻醉 2难以配合麻醉 3难于避免呕吐误吸 4麻醉药作用时间明显延长 5常伴有不同程度脱水、酸中毒 6常需支持循环功能,疼痛剧烈 病情严重 病情复杂,病情严重 病情复杂,病情紧急 饱胃,病情严重,First aid and treatment before anesthesia,原则 积极准备而不延误手术时机 确保呼吸道通畅及充分供氧 导致缺氧的原因通常有： 呼吸道梗阻：神志不清、昏迷、舌后坠、分泌物、呕吐 中枢性呼吸抑制：颅脑损伤 胸外伤 处理方法： 通畅呼吸道：吸引、口咽通气道、气管插管、气管切开 充分供氧：鼻导管、面罩、机械通气 多发伤病人应假定有颈椎损伤而做颈椎固定,Principles of anesthesia,Premedication Analgesic ，Sedative ，Anticholinergics Method of anesthesia 1. local anesthesia -it is suitable to Superficial surgery and doses should be noted intravertebral anesthesia-Caution！ general anesthesia -Common ，Light anesthesia is appropriate,Method of general anesthesia 1 anesthesia induction 1.1 Preventive measures of reflux and aspiration Large diameter of gastric tube Antacids :Cemitidine200400mg Awake tracheal intubation after topical anesthesia Cricoid pressure before intubation Inflate endotracheal tube cuff Appropriate dose anti-cholinergic drugs Injecte non-depolarizing muscle relaxants before Succinylcholin,5Circulation and respiratory management during anesthesia 5.1Circulation management 5.1.1maintain blood pressure blood volume supplement:Crystalloid, colloid, blood, plasma Vasoactive drugs: dopamine315g/kg/min,5.1.2Antiarrhythmic Drugs slow down the heart rate after ensuring ventilation and oxygen supply,and eliminating low blood volume 5.1.3 heart function Cedilanid 5.1.4Microcirculation Dextran, scopolamine ,654-2, corticosteroids, e