限制性输液与充分液体复苏在感染性休克患者围手术期麻醉中的应用研究  

Application of Limited Fluid Resuscitation and Adequate Fluid Resuscitation in Perioperative Anesthesia in Patients with Septic Shock

作　　者：纪金芬 赵敏娟[1] 袁蓉[1] 钱敏[1] 张国平[1] 

机构地区：[1]南京中医药大学附属张家港医院麻醉科,江苏张家港215600

出　　处：《现代生物医学进展》2017年第5期898-900,936,共4页Progress in Modern Biomedicine

摘　　要：目的:探究限制性输液与充分液体复苏在感染性休克患者围手术期麻醉中的应用,从而为患者治疗提供相关科学依据。方法:回顾性分析2007年2月至2015年6月期间因感染性休克入院接受治疗的82例患者的临床资料,按输液方式的不同分为研究组(限制性输液)与对照组(充分液体复苏)各41例,观察两组患者转归情况,记录患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、动脉血氧分压(PaO_2)、出血量、总输液量、尿量、术后机械通气时间及ICU住院时间。结果:术后研究组患者出现弥散性血管内凝血(DIC)5例、成人呼吸窘迫综合征(ARDS)3例,2例病情控制不佳者转为多器官功能障碍综合征(MODS),1例死亡,总发生率为26.83%;对照组患者出现DIC 8例,ARDS 7例,MODS 5例,最终出现3例死亡,总发生率为56.10%,两组患者术后转归状况比较,差异有统计学意义(P<0.05);研究组患者MAP、CVP、HR、出血量、总输液量及尿量等指标低于对照组,差异有统计学意义(P<0.05),研究组患者PaO_2显著高于对照组,差异有统计学意义(P<0.05);研究组患者术后机械通气时间及ICU住院时间比对照组短,差异有统计学意义(P<0.05)。结论:限制性输液较充分液体复苏能够显著改善感染性休克患者组织血流灌流状况,术中出血量少、术后并发症少,效果更显著,更适合在围手术期麻醉中使用。Objective： To explore the application of limited fluid resuscitation and adequate fluid resuscitation in perioperative anesthesia in patients with septic shock, so as to provide scientific basis for the treatment of patients. Methods： 82 cases of patients with septic shock admitted to hospital to accept treatment from February 2007 to June 2015 as the research object, the research data was retrospectively analyzed and the patients were randomly divided into study group（limited fluid resuscitation） and control group（adequate fluid resuscitation）, 41 cases in each group. Observed the patients prognosis of two groups and recorded the heart rate（HR）, mean arterial pressure（MAP）, central venous pressure（CVP）, arterial oxygen partial pressure（PaO2）, bleeding volume, total infusion, urine volume, postoperative mechanical ventilation time and ICU hospitalization time. Results： There were 5 cases of disseminated intravascular coagulation（DIC） in research group after the operation, 3 cases of adult respiratory distress syndrome（ARDS）, 2 cases of poor control of the disease were converted to multiple organ dysfunction syndrome（MODS）, 1 cases of death, total incidence was 26.83%; while 8 cases of DIC, 7 cases of ARDS, 5 cases of MODS, 3 cases of death, total incidence was 56.10% in control group,the difference was statistically significant of postoperative outcome of two groups（P〈0.05）; The indexes of MAP, CVP, HR, blood loss, total infusion volume and urine volume in the study group were lower than those in the control group, the difference was statistically significant（P〈0.05）, the PaO2 in the study group was significantly higher than that in the control group, the difference was statistically significant（P〈0.05）. The time of mechanical ventilation and ICU stay in the study group were shorter than those in the control group, the difference was statistically significant（P〈0.05）. Conclusion： Compared with fully liquid recovery, Restrictive transfusion could

关 键 词：限制性输液 充分液体复苏 感染性休克 手术麻醉 

分 类 号：R614[医药卫生—麻醉学] R631.4[医药卫生—外科学]