严重创伤患者术中大量输血的麻醉管理

目的：探讨创伤患者大量输血的麻醉管理。方法：回顾分析我院1996～2007年收治的33例术中输注RBC≥20U的患者的麻醉管理策略。结果：33例术前1SS评分（34．4±16．1），SOFA评分（13．0±3．1），S1（2．29±0．55），术中采取“目标靶向治疗”策略，采用输血加温、加压装置平均输注RBC（37±15）U，血浆（18±6）U，术毕Hot（24±5）％，体温（34．5±1．2）℃，PLT（42＋28）×10^12／L。术中5例死亡，余28例带管回ICU（术后11例死亡，17例存活）。结论：积极大量的液体复苏以及体温、凝血功能的维护是创伤患者救治的关键。

Anesthetic monitor of the severe-injured patients receiving blood transfusion in a great quantity during operation

Objective： To investigate the anesthetic monitor method for the severe -injured patients receiving blood transfusion in a great quantity during operation. Methods： The anesthetic data of 33 patients hospitalized from 1996 to 2007 who transfused RBC more than 20 units were retrospectively analyzed. Results： The ISS, SOFA and SI before operation were 34.4 ± 16.1, 13.0 ± 3.1 and 2.29 ± 0.55 respectively. 37 ± 15 units of RBC and 18 ± 6 units of plasma were transfused during operation based on the goal - target therapy strategy. After the operation, the Hct, body temperature and PLT were （24 ± 5）%, （34.5 ± 1.2）℃ and （42 ± 28） × 10^12/L respectively. Five patients died during operation, the others were transported to ICU with tracheal catheter, 11 died and 17 survived after operation. Conclusion： Blood transfusion in a great quantity, maintenance of body temperature and coagulation function are the key points in saving severe- injured patients.