麻醉处理在感染性休克患者中的应用效果

Application value of anesthesia in the treatment of septic shock

目的研究麻醉处理在感染性休克患者中的应用效果。方法麻醉处理的感染性休克患者25例,其中化脓性胆管炎10例,肠梗阻10例,胃穿孔5例,为这些患者提供气管插管复合全身静脉麻醉法,主要以依托咪酯或咪达唑仑,芬太尼和维库溴铵等全身麻醉。常规监测心电图、无创血压、动脉血氧分压,监测尿量、中心静脉压,行血气分析、严重低血压行有创血压监测。手术过程中,按照患者的中心静脉压与血压进行输液;为了增加血容量使用平衡盐溶液,输入适当的胶体液。帮助患者及时纠正体内酸碱度和电解质平衡。按照患者的休克程度为其提供血管活性药物与强心药物,以便帮助患者维持血压与循环灌注。结果本次研究患者均获得良好的麻醉效果,都顺利完成手术。对比麻醉处理前后25例患者的各项生命指征,差异具有统计学意义(P<0.05)。手术完成后,有17例清醒后拔管;8例送入监护病房,其中有1例因病情加重抢救无效死亡,1例出现急性肺水肿。结论使用麻醉处理感染性休克患者时,重点是麻醉方法与麻醉药物的选用,手术管理、防止患者脏器受损、维持患者各脏器功能与内环境稳定是保证手术成功的关键。

Objective To study the application effect of anesthesia in the treatment of septic shock. Methods There were 25 cases of septic shock, including 10 cases of anesthesiology department, 10 cases of intestinal obstruction, and 5 cases of gastric perforation. Tracheal intubation combined with general intravenous anesthesia was applied for patients, and it mainly depended on etomidate, midazolam, fentanyl and veeuronium. Electrocardiogram, non-invasive blood pressure, and arterial partial pressure of oxygen were under routine monitoring. Urine volume and central venous pressure were monitored. Blood gas analysis and invasive blood pressure monitoring were applied for severe hypotension. In the process of operation, infusion was conducted according to central venous pressure and blood pressure of patients. In order to increase blood volume, balanced salt solution and proper colloidal fluid were applied. Measures were taken to help patients to correct potential of hydrogen and electrolyte balance. Vasoactive drugs and cardiac were given according to the degree of shock, in order to maintain blood pressure and circulation perfusion. Results The effects of anesthesia for all patients were good, and the surgeries were all succeeded. The vital signs of 25 cases before and after anesthesia were compared, and the differences had statistical significance （P〈0.05）. After the surgery, there were 17 cases awaked after extubation, 8 cases sent into ICU, 1 death case due to rescue invalid, and 1 case with acute pulmonary edema. Conclusion The key points of anesthesia in the treatment of septic shock are method and drug selection. Operation management, prevention of organ damage, maintenance of organ function and stable internal environment are the key to successful operation.