液体目标导向治疗在冠心病患者行颈动脉内膜剥脱术的应用  

Goal-directed fluid therapy based on patients with coronary heart disease undergoing carotid endarter-ectomy

作　　者：崔博群 高志峰[1] 赵丽云[1] 马骏[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,100029

出　　处：《心肺血管病杂志》2015年第4期291-294,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生系统高层次卫生技术人才计划(2013-2-004)

摘　　要：目的：探讨目标导向治疗在冠心病患者行颈动脉内膜剥脱术中的应用。方法：择期行颈动脉内膜剥脱术的冠心病患者40例,随机分为GDT组（目标导向治疗组）和CG组（经典输液组）。所有患者均监测BP、中心静脉压（CVP）、血氧饱和度（SPO2）、尿量、出血量、晶体输入量、胶体输入量、总液体输入量及术毕乳酸值,记录ICU停留时间和总住院时间。GDT组连接Flo Trac/Vigileo心排量监测仪监测心指数（CI）,每搏量指数（SVI）及每搏变异度（SVV）。将CI≥2.5L·min^-1·m^-2为目标作为GDT组的目标导向治疗,将MAP：65-90mmHg（1 mmHg=0.133 kPa）,CVP：8-12mmHg,尿量≥0.5m L·kg^-1·h^-1为目标作为CG组的目标导向治疗。结果：两组患者性别、年龄、BMI、ASA分级、NYAH分级和手术时间差异无统计学意义。与CG组比较,GDT组晶体液用量,总入量,多巴胺用量,术毕乳酸值明显减少（P〈0.05）,胶体液用量,术中MAP,CVP明显升高（P〈0.05）,两组患者术中出血量及尿量差异无统计学意义。与CG组患者相比,GDT组患者ICU停留时间、总住院时间显著减少。结论：目标导向治疗用于合并冠心病行颈动脉内膜剥脱术能提供更好的容量治疗,可降低ICU停留时间、总住院时间。Objective： Study the application of goal-directed therapy in patients with coronary heart carotid endarterectomy. Methods： 40 cases CAD patients undergoing elective carotid endarterectomy were randomly divided into GDT（ goal-directed therapy） groups and CG（ control-group） groups. Monitoring BP,CVP,SPO2,urine,blood loss,the amount of crystals,colloids,total fluid volume,post-operation lactic acid,vasoactive medicinal amount,lactate surgery,ICU residence time,the time of hospital stay. GDT group connected Flo Trac / Vigileo cardiac output monitor to monitor CI,SVI,VV. The CI≥2. 5L·min^- 1·m^- 2as a target for goal-directed therapy GDT group,the MAP： 65-90 mmHg（ 1 mmHg = 0. 133 kPa）,CVP： 8-12 mmHg,urinary volume： ≥0. 5m L·kg^- 1·h^- 1as goal-directed therapy for the target CG group. Results： Two groups of gender,age,BMI,ASA classification,NYAH classification and surgical time difference was not statistically significant. Compared with the CG group,GDT group set the amount of liquid crystalsthe total intake of surgery lactate volume,the amount of dopamine,post-operation lactic acid significantly reduced（ P〈0. 05）,the significantly more colloids were administered in the GDT group,MAP,CVP was higher than CG group（ P〈0. 05）,two groups of patients blood loss and urine the amount of the difference was not statistically significant compared to the CG group of patients.Compared with the CG group,GDT group were significantly reduced ICU stay time and total length of hospital stay. Conclusion： Goal-directed therapy applied to merge carotid endarterectomy in patients with coronary heart disease can provide better treatment capacity,to reduce ICU stay and hospital stay.

关 键 词：目标导向治疗 冠心病 颈动脉内膜剥脱术 

分 类 号：R54[医药卫生—心血管疾病]