每搏量变异度在老年单侧髋关节置换术中预测液体治疗反应性的应用  

Intraoperative fluid optimization using stroke volume variation in elderly unilateral hip replacement patients

作　　者：刘德胜[1] 王东春[1] 刘淑娟[1] 孙波[1] 

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2014年第3期223-226,共4页Journal of Harbin Medical University

摘　　要：目的评估每搏量变异度(stroke volume variation,SVV)指导下的液体治疗是否能够使老年单侧髋关节置换术中血流动力学更稳定,器官灌注更好。方法择期行单侧髋关节置换术的老年患者60例,年龄大于65岁,被随机分为SVV组(n=30)和对照组(n=30)。SVV组在每搏量变异度指导(Vigileo/FloTrac系统)下管理液体的输注,当SVV>10%时,输注3 mL/kg的胶体液使SVV低于10%。对照组行常规监测,由麻醉医生选择输液方式和种类(晶体液或胶体液)。分别比较两组术中晶体输注量和胶体输注量及总的输液量。记录两组患者术中各时间点基础(T0),气管插管即刻(T1),插管后1 min(T2),插管后5 min(T3),手术开始即刻(T4),全髋置换完成(T5),手术结束(T6),拔管后(T7)的平均动脉压和心率。采集动脉血插管前(L0),换臼后(L1),换头后(L2)及拔管后(L3)进行血气分析,监测血浆中乳酸浓度。记录患者术中低血压事件发生的次数。结果与对照组相比,术中SVV组患者输注的晶体量(1 300 mL±264 mL和1 089 mL±232 mL;P<0.0001)和胶体量(960 mL±210 mL和756 mL±281 mL;P=0.0186)均更多,总的液体输注量也更大(2269 mL±331 mL和1 593 mL±446 mL,P<0.0001),而发生低血压的人数更少(5和12;P=0.0049)。SVV组患者在拔管后血浆乳酸值更低(1.71mmol/L±0.86 mmol/L和2.15 mmol/L±1.21 mmol/L,P<0.05)。结论老年患者行单侧髋关节置换术中在SVV指导下的液体治疗可以使血流动力学更稳定,降低手术结束后血浆乳酸水平,器官灌注更好。Objective To assess if liquid treatment under the guidance of stroke volume variation （SVV） can make the elderly unilateral hip replacement more stable hemodynamics and better organ perfusion. Methods Sixty elderly patients undergoing elective unilateral hip replacement, older than 65 years old, were randomly divided into the SVV group （n = 30） and control group （n = 30）. The SVV was maintained below 10% guided by SVV （Vigileo/FloTrac system） using colloid boluses of 3 mL/kg in SVV group. With routine surveillance, the infusion way and type （liquid or gel liquid crystal） were chosen by anesthesiologist in control group. The intraoperative crystal infusion volume and infusion of particles and the total infusion quantity of two groups were recorded. The mean arterial pressure and heart rates of each time point, including base （ T0）, endotracheal intubation （ T1 ）, immediately after intubation （ T2 ）, 5 min after intubation （ T3 ）, the operation started immediately （ T4）, total hip replacement to complete （T5）, surgery end （ T6）, after extubation （ T7 ） were recorded. The lactate concentrations in the plasma at each time point, before endotracheal intubation （ L0）, after acetabulum replacement （L1）, after the removable nipple （L2） and after extubation （L3） were monitored. The number of patients with intraoperative hypotension were recorded. Results The patients in the SVV group received more crystalloid solutio （1300 ±264 vs 1089 ±232; P 〈0. 0001 ） and colloid （960 ±210 mL vs 756 ±281 mL; P =0. 0186）. The general infusion qThe patients in the SVV group received more crystalloid solution （1300 ±264 vs 1089 ±232; P 〈0. 0001） and colloid （960 ±210 mL vs 756 ±281 mL; P =0. 0156）. The general infusion quantity of SVV group was more than the control group （2269 ±331 mL vs 1593 ±446 mL; P 〈 0. 0001 ） and a lower number of hypotensive patients were found 5 （ 16. 7 % ） vs 12 （40 % ）, （P = 0. 0049 ）. Lactate lev

关 键 词：每搏量变异度 髋关节置换术 液体治疗 器官灌注 

分 类 号：R614[医药卫生—麻醉学] R687.4[医药卫生—外科学]