去甲肾上腺素在失血性休克或感染性休克患者麻醉管理中的应用

The Effect of Norepinephrine in the Anesthesia Management with Hemorrhagic or Septic Shock

目的:研究去甲肾上腺素在失血性或感染性休克患者麻醉管理中的应用效果。方法:病例来源:2014年1月至2015年10月南昌市第三医院收治的42例失血性或感染性休克的手术患者。所有患者麻醉管理中采用血管活性药物去甲肾上腺素以维持血流动力学的稳定及保障重要脏器的灌注压。观察指标:①术毕拔管率;②麻醉不良事件率;③尿量;④不同时间点患者心率(heart rate,HR)、平均动脉压(mean arterial blood pressure,MBP)、血乳酸(blood lactic acid)的差异。结果:42例患者中,术毕拔管有40例,拔管率为95.24%。,有效地提高了平均动脉压,且心率减慢,同时组织灌注得到改善,尿量较术前增加,P<0.05。42例患者有1例出现肾脏缺血,1例严重感染性休克的患者术后48小时死亡,余未发生外周低灌注或肠管缺血等不良事件。结论:去甲肾上腺素在失血性或感染性休克患者的麻醉管理中的应用效果确切,可有效改善心率、血压、组织灌注压、尿量,且未增加麻醉风险,安全性高,值得推广。

Objective： To study the effect of norepinephrine on anesthesia management in patients with hemorrhagic or septic shock.Methods： 42 cases of surgical patients with hemorrhagic or septic shock in the Third Hospital of Nanchang City from January 2014-October 2015 were chosen. Vasoactive drugs were used in the management of anesthesia for all patients to maintain hemodynamic stability and to protect the perfusion pressure of vital organs. Outcome Measures： （1） postoperative pull tube rate; （2） anesthesia adverse event rate; （3） urine volume; （4） heart rate （HR） in patients with different time points, mean arterial blood pressure （MBP）, blood lactate, blood lactic acid differences.Results： In 42 cases, there were 40 cases in the operation and the extubation rate was 95.24%. The mean arterial pressure and heart rate were improved, and the heart rate was slowed down, the tissue perfusion was improved, and the urine volume was increased （P〈0.05）. Among the 42 cases of patients, only 1 case with renal ischemia occurred, 1 cases of severe septic shock patients 48 hours after death, and no low perfusion or bowel ischemia adverse events was occured. Conclusion： Application of norepinephrine on anesthesia management in patients with hemorrhagic or septic shock can effectively improve the heart rate, blood pressure and tissue perfusion pressure, urine volume, and did not increase the risk of anesthesia and high safety. It is worthy to be popularized.