严重创伤病人的麻醉（PPTX页）

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

2、luated.Thecommonlyusedscoringsystemincluding:1.ASAphysicalstatusscoreItisnotveryusefulfordiscriminatingsmalldifferenceinseverelyinjuredpatients.2.Glasgowcomascorescale（GCS）Indicators:EyeopeningSpontaneous4Tovoice3Topain2None1VerbalresponseOriented5Confused4Inappro

3、priatewords4Incomprehensiblewords2None1MotorresponsesObeysCommand6Localizespain5Withdraws（pain）4Flexion（pain）3Extension（pain）2None1Numericrange：3～15Lowerscoremoreseriouscoma3.RevisedTraumaScore（RTS）Indicators：Systolicbloodpressure≥89mmHg476～89mmHg350～75mmHg21～49mm

4、Hg1Nopulse0Weight0.7326Respiratoryrate10～29/min4＞29/min36～9/min21～5/min1None0Weight0.2908GlasgowComaScale13～1549～1236～824～5130Weight0.9368Numericrange0～0.784SBP×wgt+RR×wgt+GCS×wgt=TSLowerScoremoreseriousinjury4.OthersRefertothetext.MechanismsofInjuryThemechanismof

5、injurydeterminesthepatternofinjury,andtheknowledgefocusesthetreatmentprioritiesforthepatient.Forexample:PenetratingthoracictraumaBluntChesttraumaThetherapeuticapproachisquitedifferent.Blunttraumaresultsinwidespreadenergytransfertothebody.Whenthelimitsoflordtoleran

6、ceareexceeded,Tissuesaredisrupteddependingontheamountofenergytransfer.Penetratingtraumainjuresastheenergybehindthepenetratinginstrumentcausesstretchingandcrushingoftissues.Theenergydissipationprofilesofdifferentweapons（Knivesandbulletsdeterminetheanatomicdepthande

7、xtentofmaximuminjury.Traumapatients’deathdemonstrateatrimodaldistribution.Inthefirstandlargestpeakofdistributioncurve,deathfromeitherbluntorpenetratingtraumaoccursimmediatelyfollowingwidespreadlacerationofthebrainormajorbloodvessels,includingtheheart.Suchpatientsc

8、anrarelybesaved.Inthesecondpeak,exsanguinationsfromvascularinjuriescausesdeathwithinafewhourswithoutmedicaltreatment.Inadequateordelayedshockresuscitati