CAJ | 학술논문

目的探讨手术后镇静患者低血压的影响因素及预后.方法回顾2013年5月至2014年3月在北京协和医院重症医学科(ICU)住院的术后镇静及低血压患者175例.排除标准为年龄＜18岁,心脏手术、嗜铬细胞瘤手术、术后出现失血性休克、感染性休克、心源性休克.记录基础病史、肝肾功能、手术部位、术中出血量及补液量;APACHEⅡ,镇静及镇痛药物的种类和剂量;基础血压及镇静后平均动脉压、中心静脉压、扩容量、累计液体正平衡量;去甲肾上腺素剂量及使用时间;升压前后的组织灌注指标;气管插管时间,住ICU时间.结果镇静后患者平均动脉压较基础水平明显下降[(77.2±11.2) mmHg比(82.6±9.3)mmHg,P=0.000].APACHEⅡ＞10分的患者比APACHE Ⅱ≤10分的患者去甲肾上腺素剂量更大,使用时间更长.有冠心病史的患者去甲肾上腺素使用时间更长.胸腹盆手术患者、肝功能异常患者使用去甲肾上腺素剂量更大.血压下降幅度、去甲肾上腺素使用时间是气管插管时间的独立危险因素;去甲肾上腺素剂量、去甲肾上腺素使用时间是住ICU时间的独立危险因素.结论疾病严重程度、心脏基础病史、手术部位、肝功能均是手术后镇静患者低血压的危险因素.对于高危患者应注意镇静药物的剂量和给药方法.镇静后去甲肾上腺素使用时间是气管插管时间和住ICU时间的独立危险因素.
목적 탐토수술후진정환자저혈압적영향인소급예후.방법 회고2013년5월지2014년3월재북경협화의원중증의학과(ICU)주원적술후진정급저혈압환자175례.배제표준위년령＜18세,심장수술、기락세포류수술、술후출현실혈성휴극、감염성휴극、심원성휴극.기록기출병사、간신공능、수술부위、술중출혈량급보액량;APACHEⅡ,진정급진통약물적충류화제량;기출혈압급진정후평균동맥압、중심정맥압、확용량、루계액체정평형량;거갑신상선소제량급사용시간;승압전후적조직관주지표;기관삽관시간,주ICU시간.결과 진정후환자평균동맥압교기출수평명현하강[(77.2±11.2) mmHg비(82.6±9.3)mmHg,P=0.000].APACHEⅡ＞10분적환자비APACHE Ⅱ≤10분적환자거갑신상선소제량경대,사용시간경장.유관심병사적환자거갑신상선소사용시간경장.흉복분수술환자、간공능이상환자사용거갑신상선소제량경대.혈압하강폭도、거갑신상선소사용시간시기관삽관시간적독립위험인소;거갑신상선소제량、거갑신상선소사용시간시주ICU시간적독립위험인소.결론 질병엄중정도、심장기출병사、수술부위、간공능균시수술후진정환자저혈압적위험인소.대우고위환자응주의진정약물적제량화급약방법.진정후거갑신상선소사용시간시기관삽관시간화주ICU시간적독립위험인소.
Objective To explore the risk factors and prognosis of hypotension in postoperative sedation patients.Methods A total of 175 patients with postoperative sedation at our department from May 2013 to March 2014 were retrospectively reviewed.Patients with age ＜ 18 years,cardiac surgery,pheochromocytoma surgery,hemorrhagic shock,septic shock or cardiogenic shock were excluded.APACHE Ⅱ,dosage and duration of sedative drug,mean arterial pressure at baseline and after sedation,central venous pressure,fluid balance,dosage and duration of norepinephrine,endotracheal intubation time and length of intensive care unit (ICU) stay were recorded.Results Blood pressures decreased significantly after administration of sedation (77.2 ± 11.2 vs 82.6 ± 9.3 mmHg,P =0.000).Compared to those with lower disease severity (APACHE Ⅱ ≤ 10),the patients with APACHE Ⅱ.＞ 10 required higher norepinephrine dosage and longer time of infusion.A longer time of norepinephrine infusion was needed for patients with coronary heart disease.Patients undergoing thoracic,abdominal or pelvic surgery,or those with hepatic dysfunction had a higher norepinephrine dosage.Decrement of blood pressure and norepinephrine duration were independent risk factors of endotracheal intubation time.And dosage and duration of norepinephrine were independent risk factors of ICU time.Conclusion Disease severity,past history of heart disease,surgical site and liver function are risk factors of hypotension in postoperative sedation patients.It is important to pay attention to dosage and administrative route of sedative drug.Norepinephrine duration after sedation is an independent risk factor of endotracheal intubation time and ICU time.