不同容量治疗方案对老年食管癌切除术患者血流动力学、血乳酸及氧供需平衡的影响  

IMPACT OF DIFFERENT FLUID MANAGEMENT REGIMENTS ON HEMODYNAMICS,THE LACTATE CONTENT,OXYGEN DELIVERY AND CONSUMPTION IN THE OLDER PATIENTS UNDERGOING ESOPHAGECTOMY

作　　者：刘娜[1] 徐悦利[1] 李汝鸿 李玲[1] 路艳[1] 宋莺春[1] 杨宝英[2] 

机构地区：[1]承德医学院附属医院麻醉科,河北省承德市067000 [2]承德市中心医院手术室

出　　处：《中国煤炭工业医学杂志》2015年第6期966-970,共5页Chinese Journal of Coal Industry Medicine

基　　金：承德市科学技术研究与发展计划(编号:20142051)

摘　　要：目的比较常规液体治疗与目标导向液体治疗对老年食管癌根治术患者围术期血流动力学、血乳酸及氧供需平衡的影响。方法择期食管癌根治术患者45例,随机分为常规输液组（C组,n=23）和目标导向液体治疗组（G组,n=22）。C组术中补液方案：按术前禁食水丧失量＋生理需要量＋继续损失量＋第三间隙丢失量进行补液。G组术中以正常MAP、Hct、Hb为基础,维持正常值范围（800~1 000ml/m2）的胸腔内血容积指数（ITBVI）为导向目标进行补液。采用脉搏指示剂连续心排血（PiCCO）监测仪记录术前（T0）、气管插管后5min（T1）、双肺通气15min（T2）、侧卧位单肺通气15min（T3）、肺复张后双肺通气15min（T4）和术毕（T5）患者的平均动脉压（MAP）、心率（HR）、心指数（CI）、胸内血容量指数（ITBVI）、血管外肺水指数（EVLWI）的变化。采集T0,T5时点颈内静脉血和桡动脉血检测SaO2,中心静脉血氧饱和度（ScvO2）和动脉血乳酸（Lac）并计算氧供指数（DO2I）、氧耗指数（VO2I）。记录所有患者输液总量、胶体液量、失血量、尿量、手术时间以及术中糖皮质激素、血管活性药物等药物使用情况。结果二组液体治疗方案均能维持术中血流动力学稳定。与T0比,二组T1时点MAP、CI、ITBVI均显著降低（P〈0.05）。G组T4、T5时MAP明显高于C组（P〈0.05）。G组T5时CI明显高于T0,且明显高于C组（P〈0.05）。与T0比,G组T4、T5时ITBVI明显升高（P〈0.05）。二组间各时点EVLWI变化差异无统计学意义（P〉0.05）。与T0比较,C组T5时DO2I增加,G组T5时DO2I、VO2I均增加,且该时点G组明显高于C组。G组T5时Lac明显低于C组（P〈0.05）。术中G组输注液体总量显著少于C组、胶体液量显著多于C组（P〈0.05）。其余数据比较差异无统计意义（P〉0.05）。结论目标导向液体治疗能够提高老年食管癌根治术患者心输出量,维持循Objective To compare the effects of routine fluid therapy with goal - directed fluid therapy on hemodynamics, the lactate content, oxygen delivery and consumption in the older patients undergoing esophagectomy. Methods Fourty- five patients scheduled for esophagectomy were randomly allocated into goal-directed fluid therapy group （group G, n = 22） and routine fluid therapy group （group C,n = 23）. Total operative fluid balance in the group C was adjusted according to the patient＇s basal physical require- ment, preoperative fast, intraoperative lose and third space loses. The fluid therapy during the surgery in the group G was directed by maintaining intrathoracic blood volume index （ITBVI） in the normal range based on the normal MAP, Hb, Hct. The heart rate {HR） , mean artery pressure （MAP）, cardiac index （C1）, extravascular lung water index （EVLWI） and intrathoracic blood volume index （ITBVI） were recor- ded with pulse indicator continuous cardiac output （PiCCO） system at the following time points： pre- surgery （To）, 5 min after intubation （T1）, 15 rain after total lung ventilation （T2）, 15 min after one- lung vend- lation （T3）, 15 min after pulmonary re- expansion （T4） and the end of operation （T5）. SaO2 ,central ve- nous oxygen satuaration （ScvO2） and serum lactic acid content were measured at TO , T5 and the index of oxygen delivery （DO21 ） and oxygen onsumption （VO2I） were calculated. The usage of vasoactive agents and glucocorticoid, the total amount of fluid, the amount of colloid fluid, the duration of surgery, the blood loss and urinary volume were also recorded. Results Administration of goal - directed fluid therapy or rou- tine fluid therapy all maintain stable intraoperative hemodynamics. Compared with TO, MAP, CI and ITB- VI in the two groups significantly decreased at T1 （P〈0.05）. The MAP was significantly higher in the group G than in the group C at T4, T5 （ P〈0.05 ）. Compared with To, CI of group G at Ts was sign

关 键 词：目标导向液体治疗 脉搏指示剂连续心排出量 胸腔内血容积指数 食管癌根治术 

分 类 号：R735.1[医药卫生—肿瘤]