2018-03-2110:12:00中国现代医生2018年2期Ill胡菁纯潜丽俊雷李培昊炜郑旺福王武［摘要］目的探討七氟烷全麻处理脓毒血症患者的临床效果。方法将2016年3J1〜2047年2月在我院外科行手术治疗的74例脓毒血症患者按维持麻醉方式的不同分为两组，所有患者均给予全身麻醉，对照组术中采用丙泊酚维持，观察组术中七氟烷维持，比较两组患者术中生命体征变化、呼吸功能各指标变化、不良反应、手术结局。结果观察组麻醉后平均动脉压、心率较对照组控制平稳，差异冇统计学意义(PvO.05),两组在血氧饱和度上无明显差异(P>0.05)；两组术前、术中30min.手术结束、术后24h对比中，观察组在不同时间段氧合指数(OI)、二氧化碳分压(PaCO2)、气道峰压(Paw)、血乳酸、肺动态顺应性与对•照组相比有明显差异(PvO.05)；观察组发生恶心呕吐、头痛、过敏、寒战等不良反应发生率明显低于对照组，差异有统计学意义(PO.05)；两组在手术室拔出气管插管率、术后ARDS发生率、术后24h内死亡率均无明显差异(P>0.05)。结论脓毒血症患者采用七氟烷全麻维持具有良好效果，能维持术中生命体征平稳，対呼吸功能影响更小，有利于手术疗效的发挥，具有积极的临床意义。［关键词］脓毒血症；麻醉处理；七氟烷；呼吸功能［中图分类号］R614［文献标识码］B［文章编1673-9701(2018)02-0107-04［Abstract］ObjectiveToinvestigatetheclinicaleffectofsevofluranegeneralanesthesiainthetreatmentofsepsispatients.Methods74patientswithsepsiswhounderwentsurgicaltreatmentintheDepartmentofSurgeryinourhospitalfromMarch2016toFebruary2017weredividedintotwogroups,accordingtothedifferentwaysofmaintaininganesthesia・Allpatientsweregivengeneralanesthesia・Thecontrolgroupwasmaintainedwithpropofolduringoperation.Theobservationgroupwasmaintainedwithsevoflurane.Thechangesinvitalsigns,changesinrespiratoryfunctionindicators,adversereactionsandsurgicaloutcomewerecomparedbetweenthetwogroups・ResultsThemeanarterialpressureandheartrateafteranesthesiaintheobservationgroupwerecontrolledmoresmoothlythanthoseinthecontrolgroup,andthediffereneewasstatisticallysignificant(P<0.05).Therewasnosignificantdiffereneeintheoxygensaturationbetweenthetwogroups(P>0.05).Thelevelsofoxygenationindex(OI),partialpressureofcarbondioxide(PaCO2),airwaypressure(Paw),bloodlacticacidandpulmonarydynamiccomplianeeintheobservationgroupweresignificantlydifferentfromthoseincontrolgroupbeforesurgery,at30minduringtheoperatiorbattheendofsurgeryandat24haftersurgery(P<0.05)・Theincidencesofadversereactionssuchasnauseaandvomiting,headache,allergiesandchillsweresignificantlylowerthanthoseofthecontrolgroup,thedifferecewasstatisticallysignificant(P<0.05)・Therewasnosignificantdifferenceintheincideneeofendotrachealintubationremoval,postoperativeARDSincidenceandpostoperative24hmortalityintheoperatingroom(P>0.05)・ConclusionThesevofluraneappliedinsepsispatientshasgoodeffect,whichcanmaintainthevitalsignsstableduringoperation,andhaslesseffectontherespiratoryfunction.Itisconducivetothesurgicaleffect,andhasapositiveclinicalsignificance.［Keywords］Sepsis；Anesthetictreatment；Sevoflurane；Respiratoryfunction脓毒血症是临床危急重症，病情危重，进展迅速，有细菌感染引起的全身炎症反应综合征，严重威胁患者的生命。对于胃肠穿孔导致的脓毒血症需要手术修补穿孔、清除感染灶，但由于患者腹腔感染严重，全身状况较差，血流动力学波动较大，加大了手术风险，也给临床的麻醉处理带来较大困难［1-2］=本病的麻醉首选全身麻醉方法，应充分考虑药物的血流动力学效应，并注意药物对炎症反应的影响。七氟烷为临床常用吸入性麻醉药物，对肺组织缺血/再灌注损伤有一定的保护作用，有利于保护患者的呼吸功能，减少术后并发症发生［3］。本研究进一步分析...