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目的探讨重症感染性休克的麻醉处理经验。方法选择感染性休克患者11例,均采用气管插管复合静脉全身麻醉方法,以咪达唑仑或依托咪酯,维库溴铵和芬太尼等全身麻醉。常规监测心电图、无创血压、脉搏氧饱和度,监测尿量、中心静脉压,行血气分析、严重低血压行有创血压监测。术中根据血压和中心静脉压指导输液;应用平衡盐溶液增加血容量,适当输入胶体液。及时矫正电解质、酸碱平衡紊乱。根据休克程度给予血管活性药物、强心药物维持血压和循环灌注。结果所有患者均获得充分的麻醉效果,安全完成麻醉和手术。3例术毕清醒拔管。8例送监护病房,其中1例因病情重死亡,1例急性肺水肿。结论中毒性休克的麻醉处理重点是药物、麻醉方法的选择,关键是术中管理,维持内环境稳定和各脏器功能,避免脏器损伤是麻醉成功的关键。
Objective To explore the experience of anesthesia in severe septic shock. Methods Eleven patients with septic shock were selected. All patients underwent general anesthesia with tracheal intubation combined with intravenous anesthesia with midazolam or etomidate, vecuronium and fentanyl. Routine monitoring of ECG, noninvasive blood pressure, pulse oxygen saturation, monitoring urine output, central venous pressure, blood gas analysis, severe hypotension, invasive blood pressure monitoring. Intraoperative blood pressure and central venous pressure under the guidance of infusion; application of balanced salt solution to increase blood volume, appropriate input colloidal solution. Timely correction of electrolytes, acid-base balance disorders. According to the degree of shock given vasoactive drugs, cardiac drugs to maintain blood pressure and perfusion. Results All patients received adequate anesthesia to complete anesthesia and surgery safely. 3 cases of surgery clear extubation. 8 cases were sent to intensive care unit, of which 1 died of serious illness and 1 case of acute pulmonary edema. Conclusion The focus of anesthesia treatment of toxic shock is the selection of drugs and anesthesia methods. The key is intraoperative management to maintain the stability of the internal environment and the function of various organs. Avoiding organ injury is the key to successful anesthesia.