论文部分内容阅读
患儿 女,3岁,法乐四联征(上海瑞金医院确诊)。因从高处跌落,头部受伤3h,恶心呕吐,朦胧欲睡入院.CT示右颞后部硬脑膜外血肿约50ml,颅骨骨折。体检:神志恍惚,紫组,杵状指,右颞后头皮血肿。听诊胸骨左缘3、4肋间Ⅲ级以上收缩期杂音,主动脉瓣区Ⅱ级收缩期杂音。两肺呼吸音粗。实验室报告血红蛋白180g/L,红细胞5.78×10~2/L。ECG示电轴右偏,右心室肥厚,右心房负荷加重,心肌缺血。急诊开颅血肿清除。选择气管内插管,氯胺酮复合麻醉。术前30min肌注鲁米那钠30mg,阿托品0.25mg,入室平卧,面罩吸氧祛氮10min,肌注氯胺酮60mg,5min后静脉缓注羟丁酸钠1.0g,呈睡眠状态,下颌中度松弛,咽喉1％地卡因喷雾表麻1次,经口明视插入ID4.5mm气管导管,无呛咳,保留自主呼吸,接Bain装置给氧.术中心电监测,静脉追加1％氯胺酮2ml。患儿安静至手术结束.复苏顺利,吸痰拔管,无喉痉挛。历时1小时15分钟,安返病房。住院9天,
Children, 3 years old, tetralogy of Fallot (Shanghai Ruijin Hospital confirmed). Due to falling from height, head injury 3h, nausea and vomiting, hazy to sleep admitted to hospital.CT showed right temporal back epidural hematoma about 50ml, skull fracture. Physical examination: trance, purple group, clubbing refers to the right temporal scalp hematoma. Auscultation of the left margin of the sternal border 3,4 intercostal Ⅲ level systolic murmur, aortic valve area Ⅱ systolic murmur. Breath sounds coarse two lungs. Laboratory reports hemoglobin 180g / L, red blood cells 5.78 × 10 ~ 2 / L. ECG axis right deviation, right ventricular hypertrophy, right atrial load, myocardial ischemia. Emergency craniotomy hematoma removal. Select endotracheal intubation, ketamine anesthesia. 30min before surgery, intramuscular injection of luminal sodium 30mg, atropine 0.25mg, supine, oxygen mask nasal mask 10min, intramuscular injection of ketamine 60mg, 5min after slow intravenous infusion of sodium oxybate 1.0g, was asleep, moderate mandibular Relaxation, throat 1% dexamethasone Table Ma anesthesia 1 times, by mouth as ID into the ID4.5mm tracheal catheter, no cough, to maintain spontaneous breathing, then Bain oxygen device .Electrocardiogram monitoring, intravenous 1% ketamine 2ml . Children quiet until the end of surgery. Recovery smoothly, sputum extubation, no laryngospasm. Lasted 1 hour and 15 minutes, return to the ward. Hospitalized for 9 days,