每搏变异度用于食管癌患者术中补液的可行性研究  

Study of stroke volume variability-guided intraoperative transfusion in patients of esophagus cancer

作　　者：黄杰[1] 叶建荣[1] 郭海[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐市830054

出　　处：《临床麻醉学杂志》2013年第7期633-636,共4页Journal of Clinical Anesthesiology

基　　金：新疆维吾尔自治区自然科学基金(项目编号2012211A074)

摘　　要：目的探讨每搏变异度(SVV)用于食管癌患者术中补液的可行性。方法选择2010～2012年本院食管癌手术患者70例,随机数字表法均分为SVV指导补液组(A组)及常规补液组(B组)。A组:SVV值为(10±2)%指导补液,B组:根据传统4-2-1法进行补液。观察麻醉诱导前(T1)、切皮前(T2)、切开膈肌时(T3)、消化道重建吻合时(T4)、手术结束时(T5)的心输出量(CO)、HR、SBP、CVP、SV和SVV。记录术前及术后两组患者的肌酐(Cr)、尿素氮(BUN)、Hb、Hct及乳酸(Lac)的水平。记录术中晶体液输入量、胶体液输入量、出血量、尿量、芬太尼用量、手术时间、术后胃肠功能恢复时间(术后排气、排便时间和进流质、普饭时间),观察术后呼吸衰竭、吻合口瘘、消化道应激性溃疡及心律失常并发症情况。结果与T1时比较,两组T2、T4时CO、SBP和T2时SV、SVV明显降低(P<0.05);T4、T5时HR明显减慢,T3～T5时CVP明显升高(P<0.05)。与B组比较,T4、T5时A组CVP明显降低,SVV明显升高(P<0.05);A组术中晶体输入量明显减少(P<0.05)。与术前比较,术后B组的Cr、BUN和两组Hb、Hct明显降低(P<0.05)。A组术后排气、排便时间分别为(2.7±0.9)d、(3.6±0.5)d,明显短于B组的(3.9±0.7)d、(4.5±0.6)d(P<0.05)。A组术后进流质、普饭时间分别为(4.1±0.7)d、(5.8±1.1)d,明显短于B组的(4.8±0.9)d、(7.1±1.3)d(P<0.05)。两组患者均未出现呼吸衰竭、吻合口瘘、消化道应激性溃疡及心律失常并发症。结论采用SVV指导食管癌手术补液较常规补液可减少补液量、维持术中血流动力学稳定及加速患者术后胃肠功能恢复,有利于患者康复。Objective To investigate the feasibility of stroke volume variability-guided intraoperative transfusion in patients of esophagus cancer. Methods Total of 70 patients were randomly divided into two groups. Patients in group A received transfusion guided by stroke volume variation. The goal SVV was （10±2）%. Patients in group B received conventional intraoperative（the 4-2-1 rules） transfusion. CO, SV, SW, HR, and CVP were recorded at the following time points.. before anesthesia induction （T1）, before incision （T2）, at the time of open the diaphragm muscle （T3）, at the time of digestive tract reconstruction （T4）, and at the end of surgery （T5）. Postoperative gastrointestinal function recovery time, complications, preoperative renal function were assessed. Results Compared with T1, CO, SBP at T2, T4 and SV, SVV at T2 were decreased significantly in two groups （P〈0.05）; HR were slowed down at T4, T5, when CVP increased significantly at T3-T5 （P〈0. 05）. Compared with group B, CVP was significantly lower, SVV was significantly higher in group A at T4, T5 （P〈0. 05） ; The crystal input was significantly reduced in tgroup A （P〈0. 05）. Compared with the preoperative, Cr, BUN in group B and Hb, Hct in two groups decreased significantly postoperative（P〈0.05）. Flatus, defecation time in group A was （2.7 ±0. 9） d, （3.65=0. 5） d, was significantly shorter in group B （3.95±0. 7） d, （4. 5±0.6） d （P〈 0.05）. Liquid, general meal time in group A was （4. 15±0. 7d） d, （5.8±1.1） d, significantly shorter than that in group B （4.85±0.9） d, （7.15±1.3） d （P〈0. 05）. Patients had not respiratory failure, anastomotic fistula, gastrointestinal stress ulcer and arrhythmia complications in two groups. Conclusion stroke volume variability-guided intraoperative transfusion in patients of esophagus cancer could help maintaining the hemodynamic stability, reducing the transfusion volume and accelerateing gastrointestinal function recovery.

关 键 词：每搏变异度 容量管理 食管癌 术后转归 

分 类 号：R735.1[医药卫生—肿瘤]