歲月麻醉

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車禍複雜性外傷,術後死亡,討論原因 (兼論 damage control surgery)

原始連結:

患者男、28歲、因車禍傷致:1、腦內血腫(1釐米左右,無臨床症狀);2、左3—8肋骨骨拆;3、肺挫傷伴左血氣胸;4、左鎖骨骨拆;5、腰1椎體壓縮骨拆;
胸腔閉式引流27小時後X線複查:1、左肺基本復張(有血腫);聽診雙肺呼吸音基本一致,拔除引流。第二日(入院約40小時)晨擬定在臂叢下行鎖骨內固定,入室後改行全麻以力月西10mg、芬太尼0.2mg、丙泊酚100mg、司可林100mg快速誘導置入喉罩,用氨氟醚間斷吸入、1%丙泊酚靜滴維持。手術開始20分鐘左右發現氧飽合度下降為40%此時手術近完成,用了納絡酮催醒,手術30分鐘,輸液700-800ML平衡液。送回病房時病人呈似醒非醒狀,主刀下完醫囑後,發現病人情況不好,氧飽合度37-40%,面罩加壓下40-60%,轉入ICU氣管插管,湧出大量粉色泡沫痰,考慮肺水腫,機械呼吸氧飽合度仍只有70%左右,後經掄救無效死亡。
請教:1、麻醉選擇是否適宜?2、術中氧飽合度下降原因?3、考慮心衰和肺水腫能否成立?



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