两种麻醉方法在感染性休克患者中的应用研究

发布时间：2018-01-18 11:10

本文关键词：两种麻醉方法在感染性休克患者中的应用研究　出处：《中华医院感染学杂志》2017年20期 　论文类型：期刊论文

【摘要】：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(P0.05);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(P0.05);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(P0.05)。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。
[Abstract]:Objective to explore the effect of different anesthetic schemes on the operation of patients with septic shock. Methods 84 patients with septic shock who were treated in hospital from January 2014 to May 2016 were selected as study objects. They were randomly divided into observation group (n = 42) and control group (n = 42). The patients in both groups were treated with anti-shock therapy, the control group was treated with simple tracheal intubation general anesthesia, and the observation group with tracheal intubation general anesthesia combined with epidural anesthesia. The mean arterial pressure before and after operation was compared between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SPO), heart rate (HRR). The pulmonary infection rate, the distribution of pathogenic bacteria, the time of spontaneous recovery of respiration, the time of opening eyes and the degree of pain after anesthesia, and so on. Results the two groups had MAP before operation. There was no statistical significance in the comparison between SBP and DBP / SpOstis (P > 0.05). The HRR of the observation group was significantly higher than that of the control group (P 0.05). The pulmonary infection rate was 2.38 in the observation group and 9.52 in the control group (P 0.05). 11 strains of pathogenic bacteria were isolated from 5 patients with pulmonary infection, of which 6 strains were Gram-negative bacteria (54.55%), mainly Acinetobacter baumannii, and 4 strains were Gram-positive bacteria (36.36% strains). Staphylococcus aureus was the main; In the observation group, the recovery time and the VAS score were 6.72 卤1.03min and 7.33 卤0.42min, respectively. The score of 4.23 卤0.78) was significantly lower than that of the control group (10.18 卤0.92 min, 12.07 卤0.56 min). Conclusion General anesthesia combined with epidural anesthesia can improve circulation function compared with that of tracheal intubation combined with epidural anesthesia. It has good clinical effect to reduce the incidence of pulmonary infection and complications.
【作者单位】：四川省医学科学院·四川省人民医院麻醉科;
【基金】：四川省卫生和计划生育委员会基金资助项目(16PJ461)
【分类号】：R614
【正文快照】： 感染性休克是由于微生物入侵人体并产生相关毒素,微生物和毒素随血液循环至全身各处而引起全身免疫反应应答,由于免疫反应而产生的相关免疫因子、介质等物质作用于机体组织发生细胞代谢功能紊乱、体液灌注异常甚至器官衰竭[1]。目前临床研究发现影响感染性休克患者手术成功的

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