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脊髓损伤-牢记的几点
原作者: Emedhome,郑辛甜译,肖锋校对 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2015-03-03

Title: Spinal Cord Injury - Thoughts To Keep In Mind
题目:脊髓损伤-牢记的几点
Author 作者:EMedHome.com
翻译:郑辛甜 校对:肖锋

Spinal Cord Injury is bread and butter emergency medicine, but SCI does not present on a regular basis. Therefore, some pearls to keep in mind:
脊髓损伤(SCI)是急诊医学的重要内容,但是SCI并不常见。因此,有如下几点必知需谨记:
• RSI is felt to be safe with in line stabilization acutely but succinylcholine is contraindicated from 72 hrs to 6 months post-injury because of life threatening hyperkalaemia. Acute denervation causes acetylcholine receptors to spread beyond the motor end plate of the neuromuscular junction, increasing receptor exposure to succinylcholine (1,2).
• 在(颈椎)中线固定后进行RSI被认为是安全的,但是伤后72小时至6个月内要禁用琥珀酰胆碱,因为其可能会产生高血钾而威胁患者生命。急性去神经会造成乙酰胆碱受体扩散超过神经肌肉接头处的运动终板,增加琥珀酰胆碱对受体的作用。
• C-spine movement should be minimized during laryngoscopy, especially flexion, which is thought to be more dangerous to the cord than extension (1).
• 喉镜检查时应尽量避免颈椎活动,尤其是屈曲,它比拉伸对脊髓来说更危险。
• Do not sit patients up with acute high-thoracic SCI as they will have better respiratory function lying flat. The diaphragm has a greater excursion in inspiration as it is pushed into the chest by abdominal contents; if sitting, the diaphragm is pulled down by abdominal contents impeding further excursion in inspiration (1).
• 不要让急性高位胸椎脊髓损伤的患者坐起,因为平躺能使他们的呼吸功能更好。(平卧时)膈肌在吸气时活动范围更大,因为它被腹部内容物推向胸腔;而如果患者坐起,膈肌被腹部内容物拉下,限制其在吸气时的活动。
• Patients must be ‘log rolled’ off the board, ideally within 30 min after arrival in hospital. The spinal board is a transport device only and its prolonged use is associated with pressure sores (1).
• 患者必须要以“滚圆木”方式从板上挪下来,最好是在到达医院后的30分钟内。脊椎板只是转运工具,且过长时间使用与褥疮产生有关。
• Neurogenic shock is common in T2-5 injuries, resulting in a decrease in SVR, decreased inotropism, and increased vagal tone. Intermittent atropine may be required, especially before vagally stimulating procedures (e.g. laryngoscopy or tracheal suctioning) (1-3).
• 神经性休克常见于T2-5受伤,从而导致SVR降低,肌收缩力降低和迷走神经张力增加。可能需要间歇给予阿托品,尤其是在具有迷走神经刺激操作时(例如喉镜或气管吸痰)。
• Early catheterization is essential to avoid bladder overdistension that may precipitate bradycardia. Consider supra pubic catheterization if priapism is present (1,3).
• 为避免膀胱过度膨胀导致的心动过缓,早期导尿是必不可少的。如果阴茎异常勃起,可考虑耻骨弓上插管。
References 参考文献:
(1) Bonner S, et al. Contin Educ Anaesth Crit Care Pain 2013;13: 224-231.
(2) Dooney N, et al. Int J Crit Illn Inj Sci 2011; 1: 36-43.
(3) Lo v, et al. J Neurosurg Sci 201357:281-92.

文章来源:《中华急诊医学杂志》编辑部