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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 restrictive infusion and adequate liquid resuscitation in perioperative anesthesia in patients with septic shock, so as to provide relevant scientific evidence for the treatment of patients. Methods: The clinical data of 82 patients hospitalized for septic shock from February 2007 to June 2015 were retrospectively analyzed. According to different infusion methods, the study group (restricted infusion) and the control group (adequate liquid (HR), mean arterial pressure (MAP), central venous pressure (CVP), arterial oxygen pressure (PaO_2), blood loss, total fluid volume , Urine output, postoperative mechanical ventilation and hospital stay in ICU. Results: In the postoperative study group, 5 patients had diffuse intravascular coagulation (DIC), 3 patients had adult respiratory distress syndrome (ARDS), 2 patients with poor disease control turned to multiple organ dysfunction syndrome (MODS), 1 The death rate was 26.83%. There were 8 cases of DIC, 7 cases of ARDS and 5 cases of MODS in the control group. There were 3 deaths and the total incidence rate was 56.10%. There was no significant difference between the two groups (P <0.05). The MAP, CVP, HR, blood loss, total transfusion volume and urine output in the study group were lower than those in the control group (P <0.05). The PaO 2 (P <0.05). The duration of postoperative mechanical ventilation and ICU stay in study group were shorter than that in control group (P <0.05). Conclusion: Resuscitation with limited fluid infusion can significantly improve the tissue perfusion in septic shock patients with less blood loss, less postoperative complications and more effective in perioperative anesthesia.