口腔颌面部创伤的急救和麻醉处理

目的　分析总结提高口腔颌面部创伤急救和麻醉的经验。方法　回顾近 12年我科收治的 5 5例口腔、颌面部严重创伤及手术的急救与麻醉情况。结果　术毕拔管后 2例病人发生口腔颌面部出血 ,出现呼吸困难 ,1例病人术后出血窒息死亡。结论　此类病人关键在于迅速准确建立通畅的呼吸道 ;急诊口腔、颌面部的严重创伤更应该迅速吸净创面及口腔、呼吸道的血液、分泌物或异物 ,快速准确地气管插管 ;及时口腔颌面手术 ,术中应时刻警惕气管导管的位置 ,有无脱落、梗阻 ;注意血容量 ,积极扩容抗休克治疗 ;麻醉苏醒期拔管指征要严格 ,注意手术部位有无出血、渗血 ,拔管后有无气道梗阻及呼吸困难

Emergency treatment and anesthesia for serious oral and maxillofacial trauma

Objective To analize and generalize the experience about improving the emergency treatment of serious oral and maxillofacial trauma.?Methods Analyse the anesthesia methods for 55 serious oral and maxillofacial trauma surgery in the 12 years.?Results Two patients had dyspnea soon after extubation because of bleeding and one died of apnea.?Conclusion It can be concluded that in serious oral maxillofacial trauma,the key points in the emergency treatment are: establishment of free airway immediately by early intubation. Clean up the blood,secretion or foreign bodies in the wound. Because of the anesthetic machine and anesthetist are relatively far from the patient's head,attentions should be paid to position of the tracheal tube, whether it is dislocated,or blocked,blood volume, active anti shock treatment;?indication of the extubation should be strictly mastered. Attentions should also be paid to whether there are bleeding in the surgical field,and whether there is respiratory passage block and difficulty of respiration after extubation.