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患者男,60岁。因锅炉炸裂烫伤头、面、颈部及双上肢,面积20%,Ⅲ°15%,伴呼吸道烧伤、肾挫伤、头皮多处裂伤及双眼外伤。首次清创缝合及气管切开术后一周,再次行头、面、颈部肉芽创面植皮和右大腿取皮术。既往长期吸烟史。T:38.4℃,Hb:13.1g%,pH:7.389,PaO_269mmHg,PaCO_2:28mmHg,HCO_3:17.1mmol/L麻醉前用药:鲁米那0.1g、阿托品0.5mg。入室后静滴杜异合剂1ml。取皮及清理创面同时进行,分别以氯胺酮50mg、40mg静注共两次完成手术。术中监测NBP、P、R、SpO_2(脉搏血氧饱和度)。间断面罩给氧3L/分。
Male patient, 60 years old. Burned by the boiler head and face burns, face, neck and upper limbs, an area of 20%, Ⅲ ° 15%, with respiratory burn, kidney contusion, multiple scalp laceration and trauma. The first debridement and tracheotomy after a week, again the first line, face, neck granulation wounds and right thigh skin graft surgery. Past long-term smoking history. T: 38.4 ℃, Hb: 13.1g%, pH: 7.389, PaO_269mmHg, PaCO_2: 28mmHg, HCO_3: 17.1mmol / L before anesthesia medication: luminal 0.1g, atropine 0.5mg. After intravenous infusion of Du Fuli mixture 1ml. Take the skin and clean the wound at the same time, respectively, ketamine 50mg, 40mg intravenous injection to complete a total of two operations. Intraoperative monitoring of NBP, P, R, SpO_2 (pulse oximetry). Interrupted mask oxygen 3L / min.