CAJ | 학술논문

目的分析"5.12"汶川地震中德阳市第二人民医院接收的伤员行手术治疗时的麻醉方式. 方法在900多名伤员中,通过检伤分类,在72 h内对83例伤员行急诊手术,72 h后对21例伤员行择期手术,地震10 d后,需行手术治疗的伤员均转移后送至远离震区的后方医院.在所有手术伤员中,四肢伤89例(85.6%),颅脑伤11例(10.6%),胸部伤3例(2.8%),腹部伤1例(1.0%).所有手术伤员于术中监测无创血压、心电图、脉搏及血氧饱和度.除1例连枷胸伤员于术后12 h死亡外,其余均生存. 结果所有手术伤员的麻醉方式中,腰硬联合麻醉35例(33.7%),神经丛阻滞33例(31.7%),腰硬联合+神经从阻滞5例(4.8%),全身麻醉28例(26.9%)(其中行气管插管者17例,占16.4%,未行气管插管者11例,占10.6%),局部麻醉术中监测3例(2.9%).各种麻醉方式下的手术时间占该伤员在手术室停留总时间比例,全身麻醉组伤员为(51.29±12.38)%,神经丛阻滞组为(53.24±11.39)%,腰硬联合组为(58.43±9.27)%,神经丛+腰硬联合组为(77.15±9.27)%.从该比例上来看,腰硬联合+神经丛阻滞麻醉组与其余三组相比较,差异有统计学意义(P<0.01),全身麻醉、神经丛阻滞、腰硬联合麻醉三组相互比较,差异无统计学意义(P>0.05). 结论地震医疗救援早期,在属于二级救治机构的医疗场所里,短时间内手术通过量较大,伤情以四肢伤为主,腰硬联合及神经丛阻滞麻醉使用频率较高,从节省伤员手术时间、提高伤员手术通过量、保证伤员术后安全,促进伤员术后恢复等方面都表现出其良好的优势.
목적 분석"5.12"문천지진중덕양시제이인민의원접수적상원행수술치료시적마취방식. 방법 재900다명상원중,통과검상분류,재72 h내대83례상원행급진수술,72 h후대21례상원행택기수술,지진10 d후,수행수술치료적상원균전이후송지원리진구적후방의원.재소유수술상원중,사지상89례(85.6%),로뇌상11례(10.6%),흉부상3례(2.8%),복부상1례(1.0%).소유수술상원우술중감측무창혈압、심전도、맥박급혈양포화도.제1례련가흉상원우술후12 h사망외,기여균생존. 결과 소유수술상원적마취방식중,요경연합마취35례(33.7%),신경총조체33례(31.7%),요경연합+신경종조체5례(4.8%),전신마취28례(26.9%)(기중행기관삽관자17례,점16.4%,미행기관삽관자11례,점10.6%),국부마취술중감측3례(2.9%).각충마취방식하적수술시간점해상원재수술실정류총시간비례,전신마취조상원위(51.29±12.38)%,신경총조체조위(53.24±11.39)%,요경연합조위(58.43±9.27)%,신경총+요경연합조위(77.15±9.27)%.종해비례상래간,요경연합+신경총조체마취조여기여삼조상비교,차이유통계학의의(P<0.01),전신마취、신경총조체、요경연합마취삼조상호비교,차이무통계학의의(P>0.05). 결론 지진의료구원조기,재속우이급구치궤구적의료장소리,단시간내수술통과량교대,상정이사지상위주,요경연합급신경총조체마취사용빈솔교고,종절성상원수술시간、제고상원수술통과량、보증상원술후안전,촉진상원술후회복등방면도표현출기량호적우세.
Objective To analyze the anesthetic methods and surgical procedures in the treatment of inpatients in N 2 People' s Hospital of Deyang after Wenchuan earthquake. Methods More than 900 patients were sorted for injury triage, among whom 83 patients received emergency surgery within 72 hours after earthquake, and 21 received surgery after 72 hours. After 10 days of the earthquake, the hospitalized patients needing further surgery have been transferred to hospitals in safe regions. Of all patients, 89 (85.58%) were with injuries of extremities, 11 (10.6%) with cerebral trauma, 3 with thoracic injury, and 1 (1.0%) with abdominal trauma. Perioperative noninvasive blood pressure, electrocardiogram, pulse and oxygen saturation were detected during the surgery. All patients were cured except that one patient with traumatic flail chest died 12 hours after the surgery. Results Of all patients undergone surgeries, 35 patients (33.7%) received combined spinal-epidural anesthesia (CSEA), 33 (31.7%) received nerve plexus block (NPB), 5 (4.8%) had CSEA plus NPB, 28 were under general anesthesia (GA) [17 (16.3%) were intubated and 11(10.6%) were non-intubated] and 3 (2.8%) received monitored anesthesia care (MAC). The average ratios of operation time to time for patients stayed in operation room were (51.29±12.38)% in GA group, (53.24±11.39)% in NPB group, (58.43±9.26)% in CSEA group and (77.15±9.27)% in CSEA plus NPB group. There was a significant difference between CSEA + NPB group and the other three groups (P<0.01), and there was no significant difference among GA group, NPB group and CSEA group (P > 0.05). Conclusions During the initial period of rescue, the most common type of injuries are fractures. CSEA plus NPB is encouraged to use as they have the advantages of shorter operation time, higher operation throughput, safety and faster convalescence of the victims.