摘要
目的分析全身麻醉复合硬膜外麻醉对感染性休克患者血流动力学与氧代谢的影响,筛选能稳定感染性休克患者围术期血流动力学和氧代谢稳定的麻醉方案。方法选择2015年2月-2016年2月医院收治的感染性休克手术患者78例为研究对象,按照所采用的麻醉方式分为对照组38例和试验组40例,对照组采用全身麻醉,试验组采用全身麻醉复合硬膜外麻醉。比较两组患者手术前(T1)、静注麻药5min后(T2)、插管时(T3)、插管5min后(T4)、切皮5min后(T5)、拔管5min后(T6)的血流动力学指标(收缩压、舒张压、平均动脉压)及氧代谢指标(血氧饱和度(SpO2)、混合静脉血氧饱和度(SvO2)、动脉血乳酸的变化,分析全身麻醉复合硬膜外麻醉对感染性休克患者血流动力学和氧代谢的影响。比较两组患者静脉麻醉药物用量。结果两组患者年龄、性别、体质量、体重指数(BMI)、感染休克原发疾病、入室前收缩压、舒张压、平均动脉压、SpO2、SvO2、动脉血乳酸,差异无统计学意义;两组患者T2、T3、T4、T5、T6的收缩压、舒张压、平均动脉压较T1时均升高,但试验组在T2、T3、T4、T5、T6高于对照组(P<0.05);试验组患者T2、T3、T4、T5、T6时的SpO2、SvO2高于对照组,动脉血乳酸低于对照组(P<0.05)。试验组患者氯胺酮和芬太尼用量分别为(51.63±5.04)mg、(18.64±3.72)mg低于对照组(P<0.05)。结论全身麻醉复合硬膜外麻醉可降低全身麻醉用药量,降低麻醉药物对循环系统的影响,有效保持感染性休克患者血流动力学和氧代谢稳定,避免休克患者因低血压、低氧代谢而加重感染休克病情,具有重要的临床价值。
OBJECTIVE To analyze the effect of combined general and epidural anesthesia on hemodynamics and ox- ygen metabolism in patients with septic shock,and screen the stable anesthesia screening scheme in patients with septic shock in hemodynamics and oxygen metabolism in stable operation period.METHODS A total of 78 cases of patients with septic shock from Feb. 2015 to Feb. 2016 were selected as the research objects, and were divided into 38 cases of control group and 40 cases of experimental group according to the anesthesia methods. Patients in con- trol group were with general anesthesia, and in experimental group were with general anesthesia combined with epidural anesthesia. The perioperative period （T1, T2, T3, T4, TS, T6） hemodynamic indexes （systolic pres- sure, diastolic pressure and mean arterial pressure） and oxygen metabolism （oxygen saturation （SpO2）, mixed venous oxygen saturation （SvOz）, and the changes of arterial blood lactate of the two groups were compared, and the effect of general anesthesia combined with epidural effects on patients with septic shock hemodynamics and ox- ygen metabolism were analyzed. The amount of intravenous anesthetics was compared between the two groups. RESULTS The age, gender, weight, body mass index （BMI）, primary disease, infection shock burglary before systolic and diastolic blood pressure, mean arterial pressure, SpO2, SvO2, and arterial blood lactic acid betweenthe two groups had no significant differences.The systolic and diastolic pressure and mean arterial pressure in T2, T3, T4, T5, and T6 were higher than those in T1, and those in experimental group in T2, T3, T4, T5 , and T6 were higher than those in control group （P〈0.05） ; test group of patients with T2, T3, T4, T5, T6 The SpO2 and SvO2 in T2, T3, T4, T5, and T6 in experimental group were higher than those in control group, and arterial blood lactate was lower than that in control group （P 〈0.05）. The fentanyl and ketamine dosages of in experi- mental group were respectively �
作者
卢伟东
赵亮
张加强
李慧蕴
孙志国
苌恩强
LU Wei-dong;ZHAO Liang;ZHANG Jia-qiang;LI Hui-yun;SUN Zhi-guo;CHANG En-qiang(Henan Province Peoplets Hospital, Zhengzhou , Henan 450003, Chin)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第3期398-401,405,共5页
Chinese Journal of Nosocomiology
关键词
感染性休克
全身麻醉
全身麻醉复合硬膜外麻醉
血流动力学
氧代谢
影响分析
Septic shock
General anesthesia
General anesthesia combined with epidural anesthesia
Hemody-namics
Oxygen metabolism
Effect analysis
