部分体外循环麻醉在横穿颈部匕首取出术抢救中的应用  

Anesthesia and rescue for the operation of removal of a dagger through the neck

作　　者：石教辉[1] 万利芹[1] 许芬[1] 王志春[1] 汪涛[1] 

机构地区：[1]江苏省沭阳县人民医院麻醉科,223600

出　　处：《国际麻醉学与复苏杂志》2013年第6期575-576,共2页International Journal of Anesthesiology and Resuscitation

摘　　要：患者男性,17岁,血型Rh阴性,因左颈总动脉处尖刀刺人横穿颈部未拔出,血管破裂持续出血,气管破裂呼吸极度困难,失血性休克,由急诊室紧急送入手术室抢救.循环血容量严重不足和气管破裂严重误吸直接危及患者生命.适度镇静后在保持利器绝对稳定下局麻行气管切开置管,吸尽气道异物后纯氧吸入.同时防止肺通气换气功能障碍,做好使用人工心肺机的准备.开通股静脉快速补充血容量,血压相对平稳后行静脉全麻间歇正压通气.通过股动脉和股静脉插管行体外循环（cardiopulmonary bypass,CPB）,在人工心肺机帮助下改善机体缺氧和术中血液回收.开始颈部手术,术中尖刀取出后严重失血危及生命,因无RH阴性型血液,经患者家属同意后尝试输RH阳性型血,严密监测未见严重输血反应,手术顺利结束,送入重症监护室.经对症营养支持治疗,术后48 d患者康复出院.One 17-year-old male patient with Rh-negative blood type was subjected to hemorrhagic shock and anhelation.When he was sent into the opeareating room,his neck was pricked and his trachea was cut off by a dagger.The life-threatening problems were that blood volume and tidal volume were seriously insufficient.After giving effective analgesia and anesthesia drugs,we carried out tracheotomy for the patient.To supplement blood capacity in time,femoral venous puncture were made to him.When respiratory and circulation became stable,general anesthesia were carried out for him.After establishing cardiopulmonary bypass （CPB）,the operation were carry out to remove the dagger though his neck.When the dagger was take out from his neck,loss of blood became very severe.In order to rescue his life,Rh-positive blood were transfused much and no severe transfusion reaction.The operation was finished successfully.After operation,the patient was transferred to intensive care unit （ICU）,and discharged with rehabilitation for 48 days after operation.

关 键 词：颈总动脉 气管破裂 RH阴性 体外循环 

分 类 号：R614[医药卫生—麻醉学]