动脉脉压变异评价老年胃癌根治术中液体治疗的效果  

Evaluation effects of fluid therapy guided by pulse pressure variation in radical gastric cancer resection in aged patients

作　　者：李利彪[1] 乌新林[2] 刘良田[1] 于建设[1] 丁翠霞[1] 韩志强[1] 钟海燕[1] 

机构地区：[1]内蒙古医学院附属医院麻醉科,呼和浩特市010050 [2]内蒙古医学院附属医院普外科,呼和浩特市010050

出　　处：《临床麻醉学杂志》2012年第7期672-674,共3页Journal of Clinical Anesthesiology

基　　金：内蒙古自然科学基金(20080404ms1140)

摘　　要：目的探讨动脉脉压变异(PPV)评价老年患者胃癌根治术中液体补充的效果。方法 40例老年胃癌手术患者,随机均分为研究组(A组)和对照组(B组)。采用全麻复合硬膜外麻醉,麻醉后A组行右侧桡动脉穿刺置管监测有创动脉压并计算出一个呼吸周期内的PPV值。静脉快速输注复方氯化钠和琥珀酰明胶(晶体:胶体=2:1),维持PPV值在5%～10%。B组输液量和速度以麻醉医师经验进行,液体种类和比例同A组。观察记录入手术室时(T_1,基础值)、肿瘤切除完毕时(T_2)、术毕(T_3)时的BP、HR。T_1和T_3时抽动脉血监测血气,检测乳酸(Lac)和血肌酐(Cr)和尿素氮(Bun);记录两组患者尿量、输入液体量和升压药物(麻黄碱和多巴胺)的用量。观察患者的恢复情况。结果 T_2、T_3时两组HR明显慢于,SBP、DBP明显低于T_1时,且A组HR明显慢于,SBP、DBP明显高于B组(P<0.05)。T_3时B组血Lac和Bun均高于T_1时,B组术后恶心、呕吐发生率明显高于A组(P<0.05)。A组输入液体量、尿量明显多于B组,麻黄碱和多巴胺用量少于B组(P<0.05)。结论应用PPV指导老年人胃癌根治术中液体补充可以保证患者循环功能稳定、提高机体微循环灌注和减少术后恶心、呕吐的发生率,且具有良好的安全性。Objective To investigate the applicability of pulse pressure variation （PPV） to guide volume therapy in radical gastric cancer resection in aged patients. Methods Forty eider gastric cancer patients underwent radical gastric cancer resection were randomly divided into two groups （n= 20） ： experimental group （group A） and control group （group B）. All the patients received epidural aneslhesia combined with general anesthesia. The right radial artery pressure and variation during one respiratory cycle were monitored and PPV was maintained in the range of 5%-10% by gelofusine and compound sodium chloride （2 ： 1） in group A. The volume therapy in group B was decided to the anesthetist experience. BP and HR at baseline（T1）, after anesthesia（T2） and at the end of surgery （T3）, arterial blood gas analysis, serum lactate（Lac）, blood urea nitrogen （Bun） and creatinine （Cr） at T1 and T3 were recorded. Patient recovery, total urine output, infused volume and vasoactive drugs （ephedrine and dopamine） were also compared. Results SBP, DBP,and HR at T2 and T3 were lower than those at T1 （P〈0.05）and there was difference between two groups（P〈0. 05）. Arterial Lac and Bun, incidence of postoperative nausea and vomiting were higher in group B than in group A（P〈 0. 05）. Total infused volume, urine output were more and vasoactive drugs usage were less in group A than in group B. Conclusion PPV-guided volume therapy in the elderly radical gastric cancer resection can safely make the hemodynamic stable, improve microcirculatory perfusion and reduce the incidence of postoperative nausea and vomiting.

关 键 词：动脉脉压变异 胃癌 容量治疗 

分 类 号：R735.2[医药卫生—肿瘤]