重型颅脑损伤急诊手术的麻醉方法研究

目的研究分析重型颅脑损伤患者急诊手术中的麻醉方法。方法选取我院急诊手术治疗的重型颅脑损伤患者共40例,回顾性分析急诊手术中的麻醉方法和麻醉效果。结果患者HR、SBP、DBP术后水平分别为104.25±6.49次/min、13.08±3.94KP、6.52±0.84KP,均较术前得到改善(P0.01);25例术中异氟烷维持麻醉患者,未见死亡,术中至苏醒过程未见明显血压波动,并发症1例;15例术中丙泊酚维持麻醉的患者,1例死亡(因脑部并发症死亡),4例术中至苏醒血压等明显波动。异氟烷术中维持麻醉效果优于丙泊酚术中维持麻醉,差异显著(P0.05)。40例患者住院时间为20.4±2.7d,术后切口疼痛时间为2.2±0.4d;术中死亡率为2.5%,术中并发症发生率为2.5%。结论重型颅脑损伤患者急诊手术在维持呼吸通畅、供氧、抗休克、扩容同时,灵活结合病情选择麻醉方式与麻醉用药,可有效降低病死率、缩短住院时间和术后切口疼痛时间。

Research on Anesthetic Methods in Severe Brain Injury of Emergency Surgery

Objective To study the anesthesia methods in severe head injury of emergency operation. Methods Methods and effects of anesthesia in 40 patients with severe brain injury treated by emergency surgery were retrospectively analyzed. Results The level of HR,SBP,DBP after operation were 104.25±6.49 times/min,13.08±3.94KP,6.52±0.84KP, improved than before the surgery （P〈0.01）. No death but one complication was in 25 patients with isoflurane anesthesia, with no significant fluctuations in blood pressure.One died in 15 patients with propofol anesthesia, with significant fluctuations in blood pressure in 4 cases in intraoperative to wake up.The effect of isoflurane in intraoperative maintenance of anesthesia was better than propofol, the difference was significant. The hospitalization was 20.4±2.7d,postoperative wound pain time was 2.2±0.4d;death rate during operation was 2.5%,complication rate during operation was 2.5%. Conclusions In the basis of maintaining unobstructed breathing, oxygen, anti-shock, expansion, flexible choicing of anesthesia with the disease and anesthesia medication, in emergency surgery in patients with severe traumatic brain injury, can effectively reduce mortality, shorter hospital stay and postoperative incisional pain time.