老年冠心病患者胃肠道手术围手术期个体化容量治疗方案的建立与评价  

Development and evaluation of individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery： a randomized, controlled trial

作　　者：郑宏[1] 郭海[1] 叶建荣[1] 陈林[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054

出　　处：《中华胃肠外科杂志》2012年第6期564-569,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：新疆维吾尔自治区科技支疆项目重点指令性计划项目（200991126）;新疆维吾尔自治区重点学科项目[新教研（2010）7号]

摘　　要：目的建立及评价实施胃肠道手术的老年冠心病患者围手术期个体化容量治疗方案。方法2009年3月至2011年3月间在新疆医科大学第一附属医院实施胃肠道手术的60例老年（60～80岁）冠心病患者被前瞻性纳入研究．通过随机数字法将人组患者随机分为试验组和对照组，每组30例。试验组患者术中及术后转入重症监护室（ICU）24h期间采用个体化的容量治疗方案，即在心指数、每搏输出量指数、每搏变异度等指标指导下，进行滴定式容量治疗：对照组术中及术后均采用常规容量治疗方案。比较两组术后血流动力学指标、液体出入情况、心脏不良事件发生率及胃肠道功能恢复情况。结果与对照组相比，试验组患者手术开始时平均动脉压显著增高．在术中和手术结束时心指数显著增高，在麻醉诱导后、术中及ICU留置早期，每搏输出量均显著增高（均P〈O．05）。手术结束时及ICU留置期间．试验组患者血清乳酸含量明显低于对照组（P〈O．05）。术中及留住ICU24h期间，试验组患者总输液量、晶体使用量及尿量均明显少于对照组．而胶体使用量则明显多于对照组（均P〈O．05）。试验组患者围手术期心脏不良事件发生率为36．7％（11／30）．低于对照组的56．7％（17／30），但差异并未达到统计学意义（P〉O．05）。试验组术后排气时问、排粪时间、恢复进流食时间、ICU留置时间及住院时间均显著少于对照组（P〈O．05）。结论老年冠心病患者实施胃肠手术期间．应用个体化的容量治疗可有效减少各类心脏不良事件的发生．改善术后胃肠道功能并缩短住院时间。Objective To develop and evaluate an individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery. Methods In this prospective study, 60 coronary heart disease patients undergoing gastrointestinal surgery were included in the First Affiliated Hospital of Xinjiang Medical University from March 2009 to March 2012. Patients were randomized into the intervention group and the control group with 30 patients in each group. Individualized fluid therapy was used during surgery and postoperative period in the ICU, which was determined based on target controlled fluid therapy according to cardiac index, stroke volume, and stroke volume variation. Traditional fluid therapy was used in the control group in the intraoperative and postoperative period. The two groups were compared in terms of postoperative hemodynamic parameters, total fluid volume, incidence of adverse cardiac events, and recovery of bowel function. Results Compared with the control group, mean arterial pressure was significantly increased at the commencement of the surgery. The cardic index was significantly elevated during surgery and at the end of the surgery. Stroke volume was significantly increased after induction of anesthesia, during the surgery, and at the early stay of ICU period （all P〈0.05）. Serum lactic acid in the intervention group was significantly lower at the end of surgery and during ICU stay than that in the control group （all P〈 0.05）. During surgey and 24-hour stay in ICU, the total fluid volume, crystal usage, and urine were significantly less, while colloidal fluid use was significantly more in the invervention group as compared to the control group （all P〈0.05）. The perioperative adverse cardiac event rate was 36.7% （11/30） in the intervention group, lower than 56.7%（17/30） in the control group, but the difference was no statistically significance（P〉0.05）. In the intervention group, defecation time, time to first flatus, resumption of liquid intake

关 键 词：个体化容量治疗 围手术期 胃肠道手术 心脏不良事件 

分 类 号：R656[医药卫生—外科学]