目标导向液体治疗对胃肠道肿瘤手术老年患者术后康复的影响  

Effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing resection of gastrointestinal tumor

作　　者：赵国良[1] 周银燕[1] 彭沛华[1] 陈文栋[1] 李俊明[1] 邵建林[1] 蒋海燕[1] 李俊杰[1] 

机构地区：[1]昆明医科大学第一附属医院麻醉科,650032

出　　处：《中华麻醉学杂志》2015年第4期453-456,共4页Chinese Journal of Anesthesiology

基　　金：云南省社会发展科技计划项目（2012CA002）;云南省中青年学术和技术带头人后备人才资助项目（2012HB030）

摘　　要：目的 探讨目标导向液体治疗对胃肠道肿瘤手术老年患者术后康复的影响.方法 择期行胃肠道肿瘤根治术的患者100例,年龄65 ～ 90岁,性别不限,体重40～ 80 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组（n=50）：目标导向液体治疗组（G组）和常规液体治疗组（C组）.术中连续监测HR、MAP、CVP、SpO2和PETCO2.G组同时采用FloTrac/Vigileo监测系统监测心输出量（CO）、心脏指数（CI）、每搏量（SV）、每搏量指数（SVI）和每搏量变异度（SVV）.C组维持MAP 60～110 mmHg,CVP 6～ 12 cmH2O;G组维持CI 2.5～4.0 L· min-1·m-2,SVV 2％～13％,MAP 65 ～ 110mmHg,SVI 35～47 ml/m2.晶体液为复方电解质液,胶体液为130/0.4羟乙基淀粉溶液.记录术中晶体量和胶体量用量、总输液量、尿量、术中血管活性药物使用情况.记录气管拔管时间、术后首次排气时间、术后住院时间、总住院时间和总医疗费用.记录术后手术相关并发症、术中和术后心血管和肺部并发症、术后少尿、无尿和肾功能不全的发生情况.结果 与C组比较,G组术中晶体液用量、胶体液用量、总输液量和尿量减少,血管活性药物使用率升高,术后住院时间、总住院时间和首次排气时间缩短,总医疗费用降低,术后手术相关并发症、肺部并发症及心血管并发症的发生率降低（P＜0.05或0.01）.结论 基于FloTrac/Vigileo监测系统的目标导向液体治疗可显著促进胃肠道手术老年患者术后康复,具有一定的临床价值.Objective To investigate the effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing resection of gastrointestinal tumor.Methods A total of 100 elderly patients of both sexes,aged 65-90 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective radical operations for stomach,colon or rectal cancers,were included and randomly divided into 2 groups （n =50each） using a random number table：goal-directed fluid therapy group （group G） and conventional fluid therapy group （group C）.HR,mean arterial pressure,central venous pressure,arterial oxygen saturation and partial pressure of end-tidal CO2 were monitored continuously in the two groups.The FloTrac/Vigileo system was used to monitor cardiac output,cardiac index,stroke volume,stroke volume index and stroke volume variation at the same time in group G.In group C,mean arterial pressure was maintained at 60-110 mmHg,and central venous pressure at 6-12 cmH2O.In group G,cardiac index was maintained at 2.5-4.0 L · min-1 · m-2,stroke volume variation at 2％-13％,mean arterial pressure at 65-110 mmHg and stroke volume index at 35-47 ml/m2.Crystalloid solution was compound electrolyte solution,and colloid solution was hydroxyethyl starch 130/0.4.The requirement for crystalloid and colloid,total volume of fluid infused,urine volume,and requirement for vasoactive agents were recorded during operation.The time for removal of the endotracheal tube,time when the patients passed the flatus,length of hospital stay after operation,total length of hospital stay,and total medical costs were recorded.The operation-related complications after operation,and development of cadiovascular and pulmonary complications,oliguria,anuria and renal insufficiency during and after operation were recorded.Results Compared with group C,the requirement for crystalloid and colloid,total volume of fluid infused and urine volume were significantly decreased,the requirement for vasoactive agents was increased,the length of hospital stay after op

关 键 词：补液疗法 老年人 胃肠肿瘤 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]