胡菁纯 潜丽俊 雷李培 吴炜 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3月～2017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，差异有统计学意义（P<0.05），两组在血氧饱和度上无明显差异（P>0.05）；两组术前、术中30 min、手术结束、术后24 h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（P<0.05）；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（P<0.05）；两组在手术室拔出气管插管率、术后ARDS发生率、术后24 h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，对呼吸功能影响更小，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 [文章编号] 1673-9701（2018）02-0107-04

[Abstract] Objective To investigate the clinical effect of sevoflurane general anesthesia in the treatment of sepsis patients. Methods 74 patients with sepsis who underwent surgical treatment in the Department of Surgery in our hospital from March 2016 to February 2017 were divided into two groups， according to the different ways of maintaining anesthesia. All patients were given general anesthesia. The control group was maintained with propofol during operation. The observation group was maintained with sevoflurane. The changes in vital signs， changes in respiratory function indicators， adverse reactions and surgical outcome were compared between the two groups. Results The mean arterial pressure and heart rate after anesthesia in the observation group were controlled more smoothly than those in the control group， and the difference was statistically significant（P<0.05）. There was no significant difference in the oxygen saturation between the two groups（P>0.05）. The levels of oxygenation index（OI）， partial pressure of carbon dioxide（PaCO2）， airway pressure（Paw）， blood lactic acid and pulmonary dynamic compliance in the observation group were significantly different from those in control group before surgery， at 30 min during the operation， at the end of surgery and at 24 h after surgery（P<0.05）. The incidences of adverse reactions such as nausea and vomiting， headache， allergies and chills were significantly lower than those of the control group， the differece was statistically significant（P<0.05）. There was no significant difference in the incidence of endotracheal intubation removal， postoperative ARDS incidence and postoperative 24 h mortality in the operating room（P>0.05）. Conclusion The sevoflurane applied in sepsis patients has good effect， which can maintain the vital signs stable during operation， and has less effect on the respiratory function. It is conducive to the surgical effect， and has a positive clinical significance.

[Key words] Sepsis； Anesthetic treatment； Sevoflurane； Respiratory function

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]。……