Baxter F
Department of Anaesthesiology, McMaster University, St. Joseph's Hospital, Hamilton, Ontario, Canada.
Can J Anaesth. 1997 Jan;44(1):59-72. doi: 10.1007/BF03014326.
Many patients with sepsis require surgery for their management, often on an urgent or emergency basis. Anaesthetists are commonly required to manage patients with sepsis and septic shock in the operating room, past anaesthesia recovery area, and the intensive care unit. Since little has been written in the Anaesthesia literature on sepsis and septic shock, a review of this topic was considered appropriate.
References were obtained from computerized searches on the National Library of Medicine (English language), recent review articles and personal files. PRINCIPLES FINDINGS: Septic shock is a common cause of morbidity and mortality. Its presentation may be subtle or catastrophic. Successful management depends on an understanding of the pathophysiology of the syndrome, allowing rapid, appropriate resuscitation. This often requires aggressive correction of volume deficit, maintenance of adequate perfusion pressure with inotropic and vasopressor therapy, mechanical ventilation and correction of coagulopathy. Appropriate cultures must be taken and antibiotic therapy started, often empirically. Anaesthetic management should include careful haemodynamic monitoring. Anaesthesia induction and maintenance must be tailored to the haemodynamically unstable patient.
The management of the septic patient in the perioperative period presents a challenge for the anaesthetist. Haemodynamic and respiratory instability should be anticipated. Management requires multisystem intervention and careful anesthetic management.
许多脓毒症患者需要通过手术进行治疗，且常常是在紧急或急诊情况下。麻醉医生通常需要在手术室、麻醉恢复区以及重症监护病房对脓毒症和脓毒性休克患者进行管理。鉴于麻醉学文献中关于脓毒症和脓毒性休克的内容较少，因此认为对该主题进行综述是合适的。
参考文献通过对美国国立医学图书馆进行计算机检索（英文文献）、近期的综述文章以及个人文档获得。主要发现：脓毒性休克是发病和死亡的常见原因。其表现可能较为隐匿或具有灾难性。成功的管理取决于对该综合征病理生理学的理解，从而实现快速、恰当的复苏。这通常需要积极纠正容量不足，通过使用正性肌力药物和血管升压药物治疗维持足够的灌注压力，进行机械通气以及纠正凝血功能障碍。必须进行适当的培养并开始抗生素治疗，通常是经验性用药。麻醉管理应包括仔细的血流动力学监测。麻醉诱导和维持必须根据血流动力学不稳定的患者进行调整。
围手术期脓毒症患者的管理对麻醉医生而言是一项挑战。应预见到血流动力学和呼吸不稳定情况。管理需要多系统干预以及仔细的麻醉管理。
