不同麻醉方式对感染休克患者氧代谢及血流动力学的影响

Comparison on the influence of different anesthesia methods for oxygen metabolism and hemodynamics of patients with infective shock

目的:观察全麻和全麻复合硬膜外麻醉对感染休克患者氧代谢及血流动力学的影响,为感染性休克患者麻醉方式的选取提供依据。方法:选取2013年4月~2015年12月我院治疗的42例感染休克患者根据随机的原则分为对照组和观察组,对照组21例进行全麻,观察组21例进行全麻复合硬膜外麻醉,比较两组麻醉前、术中20 min及术后10 min氧代谢及血流动力学指标。结果:术中20 min及术后10 min观察组氧代谢指标中的混和静脉血氧饱和度(SvO_2)、颈内静脉血氧含量(CjvO_2)及氧耗(VO_2)水平分别为(64.81±5.99)%、(94.24±5.32)m L/L、(136.16±8.32)m L·min^(-1)·m^(-2)及(67.20±6.08)%、(95.10±5.40)ml/L、(133.15±8.17)m L·min^(-1)·m^(-2),均优于对照组的(60.11±5.81)%、(90.11±5.04)m L/L、(145.15±9.38)m L·min^(-1)·m^(-2)及(63.24±5.95)%、(92.23±5.18)m L/L、(142.24±9.11)m L·min^(-1)·m^(-2),血流动力学指标也均优于对照组(P均<0.05)。结论:全麻复合硬膜外麻醉对感染休克患者氧代谢及血流动力学的影响优于全麻,因此全麻复合硬膜外麻醉在此类患者中的应用价值相对更高。

Objective： To observe and compare the influence state of general anesthesia and general anesthesia combined with epidural anesthesia for the oxygen metabolism and hemodynamics of patients with infective shock,in order to provide evidence for the selection of anesthesia methods of the patients with infective shock. Methods： A total of 42 patients with infective shock in hospital from April 2013 to December 2015 were randomly divided into control group and observation group by the principle of random allocation,21 cases in control group were with general anesthesia,21 cases in observation group were with general anesthesia integrated with epidural anesthesia,then the oxygen metabolism and hemodynamics indexes of two groups before the anesthesia and at 20 min during the operation,at 10 min after the operation were compared. Results： The oxygen metabolism parameters including SvO_2,CjvO_2 and VO_2 were（ 64. 81 ± 5. 99） %,（ 94. 24 ± 5. 32） ml / L,（ 136. 16 ± 8. 32） m L·min^（-1）·m^（-2） and（ 67. 20 ± 6. 08） %,（ 95. 10 ± 5. 40） ml / L,（ 133. 15 ± 8. 17） m L·min^（-1）·m^（-2）respectively,and they were all better than（ 60. 11 ± 5. 81） %,（ 90. 11 ± 5. 04） ml / L,（ 145. 15 ±9. 38） m L·min^（-1）·m^（-2） and（ 63. 24 ± 5. 95） %,（ 92. 23 ± 5. 18） ml / L,（ 142. 24 ± 9. 11） m L·min^（-1）·m^（-2） of control group,the hemodynamics indexes were all better than those of control group（ all P〈0. 05）. Conclusions： The influence state of general anesthesia integrated with epidural anesthesia or the oxygen metabolism and hemodynamics of patients with infective shock are better than those of general anesthesia,so the application value of general anesthesia integrated with epidural anesthesia in the patients are relatively higher.