两种麻醉方法在感染性休克患者中的应用研究

Application of two anesthesia methods in patients with septic shock

目的探究不同麻醉方案在感染性休克患者手术中的应用效果。方法选取2014年1月-2016年5月于医院接受治疗的84例感染性休克患者为研究对象,随机分为观察组与对照组,各42例;两组患者均接受抗休克治疗,对照组采取单纯气管插管全麻,观察组采取气管插管全麻复合硬膜外麻醉。比较手术前后两组患者平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO_2)、心率(HR)、呼吸(R)等指标及肺部感染率及病原菌分布情况和麻醉后自主恢复呼吸时间、睁眼时间及疼痛程度(VAS)评分等指标。结果术前两组患者MAP、SBP、DBP、SpO_2、HR、R比较无统计学意义;术后观察组MAP、SBP、DBP、SpO_2均高于对照组,HR、R均低于对照组,差异有统计学意义(P<0.05);观察组肺部感染1例,感染率为2.38%,对照组肺部感染4例,感染率9.52%,差异有统计学意义(P<0.05);5例肺部感染患者共分离培养病原菌11株,其中革兰阴性菌6株占54.55%,以鲍氏不动杆菌为主,革兰阳性菌4株占36.36%,以金黄色葡萄球菌为主;观察组自主恢复时间、睁眼时间、VAS评分分别为(6.72±1.03)min、(7.33±0.42)min、(4.23±0.78)分显著低于对照组(10.18±0.92)min、(12.07±0.56)min、(5.12±0.62)分(P<0.05)。结论气管插管全麻复合硬膜外麻醉相较于单纯气管插管全麻能改善循环功能,降低患者肺部感染和并发症的发生率,具有良好的临床效果。

OBJECTIVE To investigate the effect of different anesthesia regimens in patients with septic shock.METHODS A total of 84 cases of septic shock patients in our hospital from Jan.2014 to May 2016 were selected as the research objects,and all patients were randomly divided into observation group and control group,with 42 cases in each group.The two groups of patients were received anti shock treatment,while patients in control group were received only tracheal intubation general anesthesia,and in observation group were received tracheal intubation general anesthesia combined with epidural anesthesia.The mean arterial pressure（MAP）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,blood oxygen saturation（SpO_2）,heart rate（HR）and respiration（R）were compared between the two groups before and after the operation.The incidence of pulmonary infection and the distribution of pathogens were compared between the two groups.The recovery time,the time of eye opening and the VAS score were compared between the two groups after anesthesia.RESULTS There was no significant difference in MAP,SBP,DBP,SpO_2,HR and R between the two groups before operation.After operation,the MAP,SBP,DBP and SpO_2 in observation group were higher than those in control group,and the HR and R were lower than those in control group,the differences were significant（P〈0.05）.There were 1 cases of pulmonary infection in observation group,with the infection rate of 2.38%,and there were 4 cases of pulmonary infection in control group,with the infection rate of 9.52%,and the differences were significant（P〈0.05）.Totally 11 strains of pathogens were isolated from 5 cases of patients with pulmonary infections,including 6 strains of gram-negative bacteria（54.55%）,mainly Acinetobacter baumannii,and 4 strains of gram-positive bacteria（36.36%）,mainly Staphylococcus aureus.The independent recovery time,eye opening time and VAS score of observation group were（6.72±1.03）min,（7.33±0.42）min and（4.23±0.78）points,which were statistically significant lower than（10.18±0.92）min,（12.07±0.56）min and（5.12±0.62）points of control group（P〈0.05）.CONCLUSION Tracheal intubation combined with epidural anesthesia can improve circulation function,reduce the incidence of pulmonary infections and complication rate,which has good clinical effect compared with general tracheal intubation anesthesia.