收缩压变异指数指导术中容量治疗对器官功能和氧运输的影响  

Influence of systolic pressure variation guided intraoperative fluid therapy on organ function and oxygen transport

作　　者：汪飞[1] 李丹[1] 黄文花[1] 

机构地区：[1]广东省惠州市中心人民医院,广东惠州516001

出　　处：《吉林医学》2010年第25期4238-4240,共3页Jilin Medical Journal

摘　　要：目的:收缩压变异指数(SPV)是优于充盈压对评估液体治疗的反应性,分析收缩压变异指数(SPV)指导术中容量治疗对器官功能和组织灌注的影响。方法:80例择期腹部大手术患者随机分成常规治疗组(对照组,n=40)和收缩压变异指数组(SPV组,n=40),SPV组容量治疗由SPV指导(触发点:SPV>10%)。在麻醉诱导后,术后3、6、12和24 h测量中心静脉氧饱和度(S_(CV)O_2)、血乳酸值、胆红素、肌酐和胃黏膜CO_2张力。结果:SPV组和对照组,手术时间分别为(5.7±2.4)h和(5.3±2.4)h,术中输注容量分别为(4 860±2 600)ml和(4 325±2 700)ml,差异有统计学意义(P<0.05)。氧运输和器官功能对比,基础值和术后24 h值,S_(CV)O_2分别为(74.5±6.5)%和(72.1±5.4)%;(79.3±7.0)%和(72.6±6.6)%,差异有统计学意义(P<0.05);血乳酸值(1.1±0.3)mmol/L和(1.1±0.5)mmol/L;(0.8±0.3)mmol/L和(1.2±0.4)mmol/L,差异有统计学意义(P<0.05)。结论:与对照组比较,SPV指导的治疗液体输注轻度增加,器官功能和组织灌注有所改善。Objective To analyze the effects of systolic pressure variation （SPV） guided intraoperative fluid management on organ function and perfusion when compared with routine care. Method Eighty patients underwent elective major abdominal surgery were randomly assigned to the control group （n = 40） and SPV group （n = 40） in which intraoperative fluid management was guided by SPV （trigger： SPV 〉 10% ）. Central venous O2 saturation （ScvO2） ,lactate and bilimbin,creatinine and gastric mucosal CO2 tension were measured after in- duction of anaesthesia, after 3,6,12 and 24 h. Results In SPV group and the control group ： duration of surgery were （ 5.7 ±2. 4） h and （5.3 ±2.4） h, and infusion volumes were （ 4 860 ± 2 600 ） ml and （ 4 325± 2 700 ） ml, were comparable between the groups. Oxygen transport and organ function were comparable ： baseline and 24 h values were （74.5± 6. 5） % and （72. 1 ± 5. g） % vs （79. 3± 7.0） % and （72. 6 ± 6. 6） % for ScvO2 and （ 1. 1 ± 0. 3 ） mmol/L and （ 1.1 ± 0. 5 ） mmol/L vs （0. 8± 0. 3 ） mmol/L and （ 1.2 ± 0. 4 ） mmol/L for lactate. Conclusion In comparison with routine care ,intraoperative SPV guided treatment is associated with slightly increased fluid administration when organ perfusion and function is less improved.

关 键 词：收缩压变异指数 术中容量治疗 器官功能 氧运输 

分 类 号：R656[医药卫生—外科学]