每搏变异度联合左室射血时间用于老年冠心病患者胃肠道手术中容量治疗的临床效果  

Effects of stroke volume variation combined with left ventricular ejection time to guide fluid therapy in elderly patients with coronary heart disease

作　　者：洪毅[1] 叶建荣[1] 韩宝义[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830011

出　　处：《临床麻醉学杂志》2015年第9期866-869,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(2012211A074)

摘　　要：目的 观察每搏变异度（SVV）联合校正左室射血时间（LVETc）用于老年冠心病患者胃肠道手术中容量治疗的效果。方法 2012年8月至2013年1月择期胃肠道手术患者40例,ASAⅡ或Ⅲ级,随机分为两组：研究组（T组）和对照组（S组）,每组20例。T组：当SVV〈13%,LVETc〉400ms时暂停补液。S组：维持术中SVV在8%～12%。记录麻醉诱导前（T1）、切皮前（T2）、消化道重建吻合时（T3）、手术结束时（T4）、拔出气管导管时（T5）的心输出量（CO）、每搏量（SV）和SVV,记录术后胃肠功能恢复等指标。结果 与S组比较,T组围术期输液量明显减少,术后带管时间明显缩短（P〈0.05）。T1～T5时两组患者CO、SV和SVV差异无统计学意义。术后3d内心脏不良事件T组有4例,S组有9例。结论老年冠心病患者实施胃肠道手术,观察SVV联合LVETc,能够更加准确地指导围术期容量治疗,防止心脏不良事件的发生。Objective To observe the effects of stroke volume variation （SVV） combined with left ventricular ejection time （LVET） to guide fluid therapy in elderly patients with coronary heart disease. Methods Forty patients with coronary heart disease, aged 65-80 years, undergoing gastroin- testinal surgery between August 2012 and January 2013 were recruited, randomly divided into two groups： SVV combined with LVET group （group T） and SVV group （group S）, n=20 for each. A FloTrac/Vigileo system was used to measure SVV, and transesophageal echocardiography was to measure LVET correction （LVETc）. Group S maintained SVV in 8 %-12% in group T： when SVV 13% fluid infusion was stoped, and LVETe） 400 ms rehydration was paused. SVV, SV, CO, CI were recorded before induction （T1）, before incision （T2）, tract anastomosis （Ta）, operation ending （T4）, extubation （T5）. Results Compared with group S, perioperative infusion volume of group T was decreased obviously, time to extubation was shortened significantly （P〈0. 05）. There was no difference in CO, SV, SVV between group S and group T. Conclusion SVV combined LVET to guide fluid therapy in elderly patients undergoing gastrointestinal surgery with coronary heart disease, can reflect the state of cardiac preload and afterload, and can be more accurately guide perioperative fluidtherapy.

关 键 词：每搏变异度 胃肠道手术 冠心病 容量治疗 

分 类 号：R614[医药卫生—麻醉学]