103例休克患者麻醉分析

103例休克患者,重度休克21例,中度休克21例,轻度休克35例。主要抗休克措施是迅速补充血容量。全麻47例,连续硬膜外麻醉38例,其他18例。全麻以气管内插管P·K·S液或神经安定镇疼剂—肌松剂或r—羟基丁酸钠—氯胺酮—肌松剂静脉复合麻醉为佳;对于经治疗病情好转的轻、中度休克患者,可应用连续硬膜外麻醉,但应慎重;局麻仅用于病情危重而行简单手术者。术中管理的关键是维持循环系统的稳定;防止缺氧和二氧化碳蓄积;维持肾功能;体温高时头部和全身降温。

Anesthetic experiences of 103 cases with shock

Recently, the 5-year results of anesthetic management of 103 cases with shock patients with severe shock 21 cases: patients with moderate shock, 47 cases: patients with slight shock, 35 cases are reported.Fluid therapy was an importment part of preoperative management.patients with slight shock were given initial treatment corresponding to 20% oy total blood volume (TBV).Blood volune loss could be compensated bf given balance: salt solution.with the proprtion of salt solution to volumt loss 3 or 4:1 at beginning.patients with modernate shock were given initial treatment corresoonding to 30% of TBV,erythrocytes must be given as whole blood ab6ut equal parts of non-erythrocyte fluid and erythrocytes calculated as whole blood(l:l).patients with severe shock were givn initial treatment corfesponding to 50% of TBV.relatively more whole blood muse be given, the ratio is about 1:2.38patients were under epidural anesthesia, 47, general anesthesia and 18, local anesthesia combined with basis anesthesia.The trachea was intubated.General anesthesia induced with low dose of thiopental (5-6mg/kg) or diazepam (10-20mg) and succinylcholine. maintained with procine-ketamine-suscciny lcholine mixed fluid or innovarmuscle relaxants or Y-OH-ketamine-muscle relaxants intravenous balance anesthesia was the safer or idealer anesthetic method for pationts with shock.The management during the course of operation includes: To maintain the circulatory system steady, to prevent hypoxemia and retention.of carbon dioxide, and to keep the renal function sufficient.whole blood and/or non-erythrocyte fluid are given to keep the hematocrit level higher than 30V%.The blood volume loss compensation is infused intravenously as possible if necessary,under continuous CVP observation.If the patient's temperature is higher, drop it down (continuous systemic hypothermia: 34-35℃) rapidly, especially the head (continuous head hypothermia: 30-32℃).