高龄冠心病心力衰竭合并感染性休克患者的麻醉管理1例报道  

Anesthesia management for an elder patients with coronary heart disease,heart failure and septic shock: a case report

作　　者：于丽云[1] 孙立智[1] 韩文勇 吴智宏[1] 李洋 YU Li-yun;SUN Li-zhi;HAN Wen-yong;WU Zhi-hong;LI Yang(Department of Anesthesia, Beijing Electric Power Hospital, Beijing 100073, China)

机构地区：[1]北京电力医院麻醉科

出　　处：《中国当代医药》2019年第24期195-198,共4页China Modern Medicine

摘　　要：感染性休克患者手术麻醉风险很高,当冠心病心力衰竭合并感染性休克时增加了麻醉管理的复杂性,冠心病心力衰竭与感染性休克的液体治疗原则相互矛盾,前者应当限制液体的入量,后者应该尽早开始液体治疗恢复有效循环容量;感染性休克患者一般需要使用去甲肾上腺素、肾上腺素、多巴胺维持血压,这些药物可能加剧心肌缺血,对于冠心病心力衰竭合并感染性休克的患者尚不确定是否应该使用小剂量硝酸甘油改善心肌血供。本文报道1例高龄冠心病心力衰竭合并感染性休克患者进行手术的麻醉过程,结合文献探讨该类患者的液体治疗原则和硝酸甘油使用的必要性。冠心病心力衰竭合并感染性休克的患者应尽早开始液体治疗,该类患者早期救治期间使用硝酸甘油无确切的益处。Patients with septic shock have a higher risk of surgical anesthesia. The anesthesia is more complex for the patient complicated with coronary heart disease, heart failure and septic shock. The fluid therapy strategies of septic shock therapy are inconsistent with those of heart failure and coronary heart disease. Heart failure and coronary heart disease should limit fluid intake. Patients with septic shock should begin fluid therapy as soon as possible to restore effective circulating volume. Patients with septic shock generally need to use Norepinephrine, Epinephrine or Dopamine to maintain blood pressure. These drugs may aggravate myocardial ischemia. It is uncertain whether low-dose Nitroglycerin should be used to improve myocardial blood supply for patients complicated with coronary heart disease, heart failure and septic shock. The article introduces the anesthesia process of an elderly patient with coronary heart disease and heart failure complicated with septic shock in order to explore the strategy of fluid therapy and the necessity of Nitroglycerin use in the special patients. The special patients should start fluid therapy as soon as possible, and there is no definite benefit of Nitroglycerin during early treatment in this group of patients.

关 键 词：脓毒症 感染性休克 心功能衰竭 心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]