(精品)严重创伤病人的麻醉

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1、严重创伤病人的麻醉AnesthesiaforTraumaInadvancedcountries,injuryranksasthefourthleadingcauseofdeathfollowingheartdisease,cancer,andcerebrovasculardisease.PreoperativeAssessmentFortraumapatients,inadditiontotheordinarypreanestheticevaluation,theseverityofthetraumashouldbeevaluated.Thecommonlyused

2、scoringsystemincluding:1.ASAphysicalstatusscoreItisnotveryusefulfordiscriminatingsmalldifferenceinseverelyinjuredpatients.2.Glasgowcomascorescale（GCS）Indicators:EyeopeningSpontaneous4Tovoice3Topain2None1VerbalresponseOriented5Confused4Inappropriatewords4Incomprehensiblewords2None1Motor

3、responsesObeysCommand6Localizespain5Withdraws（pain）4Flexion（pain）3Extension（pain）2None1Numericrange：3～15Lowerscoremoreseriouscoma3.RevisedTraumaScore（RTS）Indicators：Systolicbloodpressure≥89mmHg476～89mmHg350～75mmHg21～49mmHg1Nopulse0Weight0.7326Respiratoryrate10～29/min4＞29/min36～9/min21～

4、5/min1None0Weight0.2908GlasgowComaScale13～1549～1236～824～5130Weight0.9368Numericrange0～0.784SBP×wgt+RR×wgt+GCS×wgt=TSLowerScoremoreseriousinjury4.OthersRefertothetext.MechanismsofInjuryThemechanismofinjurydeterminesthepatternofinjury,andtheknowledgefocusesthetreatmentprioritiesforthepat

5、ient.Forexample:PenetratingthoracictraumaBluntChesttraumaThetherapeuticapproachisquitedifferent.Blunttraumaresultsinwidespreadenergytransfertothebody.Whenthelimitsoflordtoleranceareexceeded,Tissuesaredisrupteddependingontheamountofenergytransfer.Penetratingtraumainjuresastheenergybehin

6、dthepenetratinginstrumentcausesstretchingandcrushingoftissues.Theenergydissipationprofilesofdifferentweapons（Knivesandbulletsdeterminetheanatomicdepthandextentofmaximuminjury.Traumapatients’deathdemonstrateatrimodaldistribution.Inthefirstandlargestpeakofdistributioncurve,deathfromeithe

7、rbluntorpenetratingtraumaoccursimmediatelyfollowingwidespreadlacerationofthebrainormajorbloodvessels,includingtheheart.Suchpatientscanrarelybesaved.Inthesecondpeak,exsanguinationsfromvascularinjuriescausesdeathwithinafewhourswithoutmedicaltreatment.Inadequateordelayedshockresuscitati