地震后颈椎损伤患者的麻醉处理
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摘要
目的:总结地震所致颈椎损伤患者的麻醉处理经验。方法:回顾性分析我院麻醉科在汶川大地震中救治的6例颈椎损伤患者的围手术期麻醉管理资料,总结相关经验。结果:经过抗休克、稳定生命体征等处理后,6例伤员(3例野外条件下伤员采用慢诱导清醒盲探插管;3例后送至医院本部的伤员采用纤维支气管镜插管)在全麻下成功实施手术,术中呼吸、循环平稳,术后恢复良好。结论:野外条件下,清醒盲探插管是颈椎损伤患者的良好选择;在后方医院麻醉时气管插管宜选择颈椎活动小的纤维支气管镜插管。
Objective:To summarize our experience on anesthesia management of patients who suffered from cervical spine injury after earthquake.Methods:The anesthesia management data of the 6 patients suffering from cervical spine injury during Wenchuan Earthquake(May 12,2008,China)were retrospectively analyzed.Results:After antishock treatment and stabilization of vital signs,the 6 patients underwent surgery under general anesthesia in an open field hospital(intubation was conducted with slow induction)or in our hospital(intubation was conducted with bronchofibroscope).During operation the patients showed smooth respiratory and cardiovascular characteristics,and recovered well after operation.Conclusion:Under the field condition,intubation with slow induction is a good choice for patients with cervical spine injury;while in a hospital,intubation with bronchofibroscope should be chosen because it causes less movement of cervical spine.
Objective:To summarize our experience on anesthesia management of patients who suffered from cervical spine injury after earthquake.Methods:The anesthesia management data of the 6 patients suffering from cervical spine injury during Wenchuan Earthquake(May 12,2008,China)were retrospectively analyzed.Results:After antishock treatment and stabilization of vital signs,the 6 patients underwent surgery under general anesthesia in an open field hospital(intubation was conducted with slow induction)or in our hospital(intubation was conducted with bronchofibroscope).During operation the patients showed smooth respiratory and cardiovascular characteristics,and recovered well after operation.Conclusion:Under the field condition,intubation with slow induction is a good choice for patients with cervical spine injury;while in a hospital,intubation with bronchofibroscope should be chosen because it causes less movement of cervical spine.
引文
[1]叶晓健,袁红斌,何海龙,许国华,卢旭华,徐海涛,等.地震后四肢瘫伤员在野外环境下的急诊救治[J].第二军医大学学报,2008,29:581-582.
[2]Bonhomme V,Hartstein G,Hans P.The cervical spine in trau-ma:implications for the anaesthesiologist[J].Acta Anaesthesi-ol Belg,2005,56:405-411.
[3]Manninen P H,Jose G B,Lukitto K,Venkatraghavan L,El Beheiry H.Management of the airway in patients undergoing cervical spine surgery[J].J Neurosurg Anesthesiol,2007,19:190-194.
[4]Manoach S,Paladino L.Manual in-line stabilization for acute airway management of suspected cervical spineinjury:historical reviewand current questions[J].Ann Emerg Med,2007,50:236-245.
[5]Crosby E T.Airway management in adults after cervical spinetrauma[J].Anesthesiology,2006,104:1293-318.
[6]Robitaille A,Williams S R,Tremblay M H,Guilbert F,Thériault M,Drolet P.Cervical spine motion during tracheal in-tubation with manual in-line stabilization:direct laryngoscopy versus GlideScope videolaryngoscopy[J].Anesth Analg,2008,106:935-941.
[7]蒋京京,刘虎,徐海涛,叶军青,王成才,袁红斌.地震后挤压伤患者野外条件下的围手术期麻醉管理[J].第二军医大学学报,2008,29:586-587.
[8]Singhal B,Mohammed A,Samuel J,Mues J,Kluger P.Neuro-logical outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury[J].Spinal Cord,2008May13.[Epub ahead of print]
[9]Heidegger T,Gerig H J,Henderson J J.Strategies and algo-rithms for management of the difficult airway[J].Best Pract Res Clin Anaesthesiol,2005,19:661-674.
[10]宋德富.鼻腔盲探插管术用于严重颈椎损伤困难气管插管[J].汕头大学医学院学报,1998,11:36-37.
[11]Ollerton J E,Parr MJ,Harrison K,Hanrahan B,Sugrue M.Poten-tial cervical spineinjury and difficult airway management for emer-gencyintubation of trauma adults in the emergency department-a systematic review[J].Emerg Med J,2006,23:3-11.
[2]Bonhomme V,Hartstein G,Hans P.The cervical spine in trau-ma:implications for the anaesthesiologist[J].Acta Anaesthesi-ol Belg,2005,56:405-411.
[3]Manninen P H,Jose G B,Lukitto K,Venkatraghavan L,El Beheiry H.Management of the airway in patients undergoing cervical spine surgery[J].J Neurosurg Anesthesiol,2007,19:190-194.
[4]Manoach S,Paladino L.Manual in-line stabilization for acute airway management of suspected cervical spineinjury:historical reviewand current questions[J].Ann Emerg Med,2007,50:236-245.
[5]Crosby E T.Airway management in adults after cervical spinetrauma[J].Anesthesiology,2006,104:1293-318.
[6]Robitaille A,Williams S R,Tremblay M H,Guilbert F,Thériault M,Drolet P.Cervical spine motion during tracheal in-tubation with manual in-line stabilization:direct laryngoscopy versus GlideScope videolaryngoscopy[J].Anesth Analg,2008,106:935-941.
[7]蒋京京,刘虎,徐海涛,叶军青,王成才,袁红斌.地震后挤压伤患者野外条件下的围手术期麻醉管理[J].第二军医大学学报,2008,29:586-587.
[8]Singhal B,Mohammed A,Samuel J,Mues J,Kluger P.Neuro-logical outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury[J].Spinal Cord,2008May13.[Epub ahead of print]
[9]Heidegger T,Gerig H J,Henderson J J.Strategies and algo-rithms for management of the difficult airway[J].Best Pract Res Clin Anaesthesiol,2005,19:661-674.
[10]宋德富.鼻腔盲探插管术用于严重颈椎损伤困难气管插管[J].汕头大学医学院学报,1998,11:36-37.
[11]Ollerton J E,Parr MJ,Harrison K,Hanrahan B,Sugrue M.Poten-tial cervical spineinjury and difficult airway management for emer-gencyintubation of trauma adults in the emergency department-a systematic review[J].Emerg Med J,2006,23:3-11.
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