颅脑外伤手术麻醉处理的临床体会(1)
doi：10.3969/j.issn.1007-614x.2014.15.7
摘 要 目的：总结颅脑外伤手术麻醉处理经验。方法：2012年12月-2013年12月收治颅脑外伤患者76例，男46例，女30例，年龄13～77岁，平均55.5岁。疾病类型：硬膜下血肿11例，硬膜外血肿 36例，颅内血肿25例，其他4例。所有患者均采用气管插管全身麻醉。结果：本组76例患者麻醉效果均满意，术毕意识障碍仍存在者3例，行气管切开或保留气管插管。其他73例患者麻醉诱导过程平稳，术毕能迅速恢复苏醒状态。本组术后有11例患者由于并发症严重，术后几日意识障碍仍存在。经过治疗，76例患者中发生肺部感染6例，死亡9例，病死率11.8%。结论：采用异丙酚、咪达唑仑、维库溴胺、芬太尼麻醉治疗颅脑损伤疗效显著，值得推广。
关键词 颅脑外伤 手术麻醉 临床体会
Clinical experience of anesthesia in craniocerebral trauma operation
Zhang Chunhong
Department of Anesthesiology，Pingzhuang Mining area Medical Group General Hospital of Yuanbaoshan District，Chifeng City，Inner Mongolia Autonomous Region 024076
Abstract Objective：To summarize the experience of anesthetic in craniocerebral trauma operation.Methods：76 patients with craniocerebral trauma were selected from December 2012～December 2013.In 76 patients，46 cases were male，30 cases were female，aged 13～77 years old，and the average age was 55.5 years old.The type of the disease：11 cases with subdural hematoma，36 cases with epidural hematoma，25 cases with intracranial hematoma，4 cases with other type of craniocerebral trauma.All patients were treated with tracheal intubation general anesthesia.Results：76 patients were satisfied with the anesthesia effect，3 cases were still disturbance of consciousness after operation，then they were tracheotomy or tracheal intubation.Anesthesia induction were smoothly in other 73 patients，and they were recoved rapidly after operation.11 patients keep disturbance of consciousness for a few days after the surgery because of serious complications.In 76 patients，6 cases got pulmonary infection after treatment，9 patients died，the mortality was 11.8%.Conclusion：The curative effect of anesthesia treatment with propofol，midazolam，vecuronium bromide，fentanyl on craniocerebral injury is remarkable，it worthy of promotion.
Key words Craniocerebral trauma；Anesthesia in operation；Clinical experience
颅脑损伤(Traumatic brain injury)是比较常见的一种外伤[1]，多是由于交通事故、殴打等导致的，致残率和死亡率较高，及时手术治疗是治疗的关键[2]。为总结颅脑外伤手术麻醉处理经验，进一步提高治疗质量，2012年12月-2013年12月收治颅脑外伤患者76例，进行总结和分析，现报告如下。
资料与方法
2012年12月-2013年12月收治颅脑外伤患者76例，男46例，女30例，年龄13～77岁，平均55.5岁。疾病类型：硬膜下血肿11例，硬膜外血肿36例，颅内血肿25例，其他4例。
麻醉方法：76例患者均进行气管插管全身麻醉，静脉给予异丙酚1.5～2.0mg/kg，咪达唑仑0.03～0.05mg/kg，维库溴胺0.1mg/kg，芬太尼3～5μg/kg行快速诱导插管，用呼吸机控制呼吸，呼吸频率12次/分，潮气量8～10ml/kg，在适当过度通气调节后动脉血二氧化碳分压保持在25～30mmHg。术中麻醉可间断追加维库溴胺和吸入异氟醚，持续泵入异丙酚、瑞芬太尼进行维持[3]。加强术中监测，避免麻醉的不良反应，要及时发现异常情况，并及时处理。避免发生气道不通畅、二氧化碳潴留和缺氧的情况，应立即进行处理。主要处理措施为过度通气，由于过度通气，患者脑血管中碳酸浓度明显降低，可致颅内压下降，血容量减少；利尿剂对于颅脑外伤脑疝患者最适宜。另外，在患者输血、输液过程中要密切观察，严格控制补液输血量。, http://www.100md.com(张春红)
摘 要 目的：总结颅脑外伤手术麻醉处理经验。方法：2012年12月-2013年12月收治颅脑外伤患者76例，男46例，女30例，年龄13～77岁，平均55.5岁。疾病类型：硬膜下血肿11例，硬膜外血肿 36例，颅内血肿25例，其他4例。所有患者均采用气管插管全身麻醉。结果：本组76例患者麻醉效果均满意，术毕意识障碍仍存在者3例，行气管切开或保留气管插管。其他73例患者麻醉诱导过程平稳，术毕能迅速恢复苏醒状态。本组术后有11例患者由于并发症严重，术后几日意识障碍仍存在。经过治疗，76例患者中发生肺部感染6例，死亡9例，病死率11.8%。结论：采用异丙酚、咪达唑仑、维库溴胺、芬太尼麻醉治疗颅脑损伤疗效显著，值得推广。
关键词 颅脑外伤 手术麻醉 临床体会
Clinical experience of anesthesia in craniocerebral trauma operation
Zhang Chunhong
Department of Anesthesiology，Pingzhuang Mining area Medical Group General Hospital of Yuanbaoshan District，Chifeng City，Inner Mongolia Autonomous Region 024076
Abstract Objective：To summarize the experience of anesthetic in craniocerebral trauma operation.Methods：76 patients with craniocerebral trauma were selected from December 2012～December 2013.In 76 patients，46 cases were male，30 cases were female，aged 13～77 years old，and the average age was 55.5 years old.The type of the disease：11 cases with subdural hematoma，36 cases with epidural hematoma，25 cases with intracranial hematoma，4 cases with other type of craniocerebral trauma.All patients were treated with tracheal intubation general anesthesia.Results：76 patients were satisfied with the anesthesia effect，3 cases were still disturbance of consciousness after operation，then they were tracheotomy or tracheal intubation.Anesthesia induction were smoothly in other 73 patients，and they were recoved rapidly after operation.11 patients keep disturbance of consciousness for a few days after the surgery because of serious complications.In 76 patients，6 cases got pulmonary infection after treatment，9 patients died，the mortality was 11.8%.Conclusion：The curative effect of anesthesia treatment with propofol，midazolam，vecuronium bromide，fentanyl on craniocerebral injury is remarkable，it worthy of promotion.
Key words Craniocerebral trauma；Anesthesia in operation；Clinical experience
颅脑损伤(Traumatic brain injury)是比较常见的一种外伤[1]，多是由于交通事故、殴打等导致的，致残率和死亡率较高，及时手术治疗是治疗的关键[2]。为总结颅脑外伤手术麻醉处理经验，进一步提高治疗质量，2012年12月-2013年12月收治颅脑外伤患者76例，进行总结和分析，现报告如下。
资料与方法
2012年12月-2013年12月收治颅脑外伤患者76例，男46例，女30例，年龄13～77岁，平均55.5岁。疾病类型：硬膜下血肿11例，硬膜外血肿36例，颅内血肿25例，其他4例。
麻醉方法：76例患者均进行气管插管全身麻醉，静脉给予异丙酚1.5～2.0mg/kg，咪达唑仑0.03～0.05mg/kg，维库溴胺0.1mg/kg，芬太尼3～5μg/kg行快速诱导插管，用呼吸机控制呼吸，呼吸频率12次/分，潮气量8～10ml/kg，在适当过度通气调节后动脉血二氧化碳分压保持在25～30mmHg。术中麻醉可间断追加维库溴胺和吸入异氟醚，持续泵入异丙酚、瑞芬太尼进行维持[3]。加强术中监测，避免麻醉的不良反应，要及时发现异常情况，并及时处理。避免发生气道不通畅、二氧化碳潴留和缺氧的情况，应立即进行处理。主要处理措施为过度通气，由于过度通气，患者脑血管中碳酸浓度明显降低，可致颅内压下降，血容量减少；利尿剂对于颅脑外伤脑疝患者最适宜。另外，在患者输血、输液过程中要密切观察，严格控制补液输血量。, http://www.100md.com(张春红)