白蛋白联合小剂量呋塞米对大面积烧伤手术患者肺功能和全身麻醉苏醒时间的影响*

目的 探讨白蛋白联合小剂量呋塞米对大面积烧伤手术患者肺功能和全身麻醉苏醒时间的影响。方法 选取2015年3月—2018年4月石家庄市第一医院全身麻醉下行大面积烧伤切痂植皮手术患者40例作为研究对象。患者分为观察组和对照组，每组20例。年龄21～67岁。ASAⅡ、Ⅲ级，术前血浆白蛋白>27～ 35?g/L。观察组手术开始时即持续泵入白蛋白10?g/h，同时给予小剂量呋塞米5?mg，液体治疗采用限制性输液方法，晶体液以300～400?ml/h持续输入，不使用胶体，必要时根据失血量输入红细胞、血浆等。对照组采用常规输液方法，麻醉诱导前即以500?ml晶体液开始扩容，术中根据中心静脉压、血压和失血量补充晶体、胶体及血液。比较两组患者氧合指数、乳酸、潮气量、气道峰值压力、平均气道压、动态肺顺应性、输液总量和全身麻醉苏醒时间。结果 对照组氧合指数和肺顺应性在手术结束时低于手术开始前，气道峰压和平均气道压高于手术开始前（P?<0.05），而观察组这些指标无变化（P?>0.05）；观察组氧合指数和肺顺应性高于对照组，气道峰压低于对照组（P?<0.05），观察组输液总量少于对照组（P?<0.05），全身麻醉苏醒时间观察组短于对照组（P?<0.05）。结论 白蛋白与小剂量呋塞米联合使用，可以改善大面积烧伤手术患者肺氧合功能，降低气道峰压和平均气道压，提高肺顺应性，有利于患者快速苏醒。

Effect of albumin combined with low dose furosemide on pulmonary function and general anesthesia recovery time in patients with extensive burns*

Objective To study the effect of albumin combined with low dose furosemide on pulmonary function and general anesthesia recovery in patients with extensive burns. Methods Forty patients with extensive burns, aged 23 to 67 years, of American Society of Anesthesiologists physical status II or III, with preoperative serum albumin less than 35?g/L, scheduled for skin grafting surgery under general anesthesia, were divided into either observation group or control group (n?=?20). The observation group adopted restrictive infusion method. At the beginning of operation, albumin 10 g/h was continuously pumped and 5mg furosemide was given. The crystal liquid was continuously infused at 300 to 400?m/h without using colloid. The red blood cells and plasma were used when necessary. The control group was given conventional infusion. Before the induction of anesthesia, the 500?ml crystal solution was given to expand blood volume. In the operation, the crystal, colloid fluid or blood were supplemented according to central venous pressure, blood pressure and blood loss. The oxygenation index (OI), lactic acid (Lac), tidal volume (VT), peak airway pressure (Ppeak), mean airway pressure (Pmean) lung dynamic compliance (Cdyn), total volume of infusion and recovery time of general anesthesia were compared between the two groups. Results In the control group, the OI and Cdyn were lower, and the Ppeak, and Pmean was higher at the end of operation than before operation (P??0.05). Compared with the control group, the OI and Cdyn of the observation group were higher at the end of operation, and the Ppeak was lower (P?