Safety evaluation of rapid sequential induction anesthesia in patients with emergency gastrointestinal perforation and shock
快速序贯诱导麻醉在急诊消化道穿孔合并休克患者中的安全性评价

摘要

目的 评价快速序贯诱导麻醉在急诊消化道穿孔合并休克患者中的安全性及有效性。方法 选取2023年1月至2025年6月期间于本院急诊科收治的48例消化道穿孔合并休克患者为研究对象，根据麻醉诱导方式分为快速序贯诱导组24例和传统诱导组24例。快速序贯诱导组采用瑞马唑仑5mg、顺阿曲库铵10mg、依托咪酯10-12mg进行序贯诱导，传统诱导组采用常规快速诱导方案。比较两组患者麻醉诱导期血流动力学稳定性、插管条件、术中血流动力学变化及术后恢复情况。结果 快速序贯诱导组麻醉诱导后平均动脉压下降幅度明显小于传统诱导组，心率变化幅度更小。快速序贯诱导组插管条件优良率显著高于传统诱导组，术中血管活性药物使用率较低。术后苏醒时间快速序贯诱导组较传统诱导组显著缩短，术后恶心呕吐发生率更低。结论 快速序贯诱导麻醉在急诊消化道穿孔合并休克患者中具有更好的血流动力学稳定性和安全性，有助于改善患者预后。

Abstract

Objective To evaluate the safety and efficacy of rapid sequential induction anesthesia in emergency patients with gastrointestinal perforation complicated by shock.
Methods A total of 48 patients with gastrointestinal perforation complicated by shock admitted to the emergency department of our hospital from January 2023 to June 2025 were selected as the study subjects. They were divided into a rapid sequential induction group (n=24) and a traditional induction group (n=24) based on the anesthesia induction method. The rapid sequential induction group underwent sequential induction with remifentanil 5 mg, cis-atracurium 10 mg, and etomidate 10-12 mg, while the traditional induction group received a conventional rapid induction protocol. The hemodynamic stability during anesthesia induction, intubation conditions, intraoperative hemodynamic changes, and postoperative recovery were compared between the two groups.
Results In the rapid sequential induction group, the decrease in mean arterial pressure after anesthesia induction was significantly smaller than that in the traditional induction group, and the change in heart rate was less pronounced. The excellent rate of intubation conditions in the rapid sequential induction group was significantly higher than that in the traditional induction group, and the use of vasoactive drugs during surgery was lower. The postoperative recovery time was significantly shorter in the rapid sequential induction group compared to the traditional induction group, and the incidence of postoperative nausea and vomiting was lower.
Conclusion   Rapid sequential induction anesthesia provides better hemodynamic stability and safety in emergency patients with gastrointestinal perforation complicated by shock, which is beneficial for improving patient prognosis.