围术期目标导向液体治疗用于老年高危患者的研究  

Effect of perioperative goal-directed fluid therapy on high risk elderly patients

作　　者：郑彬[1] 郭静文[1] 唐晶晶[1] 罗兵[1] 阮祥才[1] 许立新[1] 佘守章[1] 

机构地区：[1]广州市第一人民医院麻醉科,广州510180

出　　处：《广州医药》2016年第2期17-20,共4页Guangzhou Medical Journal

基　　金：广东省医学科研基金(A2013502)

摘　　要：目的评价围术期目标导向液体治疗用于老年高危患者的优越性。方法 50例行择期全髋关节置换术的老年患者,随机分成传统液体治疗组(C组)和目标导向治疗组(GDT组),每组25例。C组以MAP和CVP为指导进行围术期液体管理,GDT组以每搏量(SV)和氧供指数(DO2I)最大化进行围术期液体管理。观察和比较两组患者围术期液体出入量、MAP、HR、SV和CI等参数。结果 GDT组总输液量、晶体液和胶体液的输注总量均高于C组(P<0.05);GDT组各时点MAP、HR、SV和CI高于C组(P<0.05),与基础值比较,GDT组无变化,而C组在麻醉后和应用骨水泥后,MAP、HR、SV和CI一过性下降(P<0.05)。结论与传统围术期液体管理方案相比,以SV和DO2I最大化为目标的GDT方案用于高危病人全髋置换手术,能使心脏前负荷处于更理想的充盈状态,血流动力学更稳定,并能有效预防骨水泥引起的循环抑制作用。Objective To evaluate the priority of goal-directed fluid therapy（ GDT） in high risk elderly patients.Methods Fifty elderly patients undergoing total hip replacement were randomly divided into traditional fluid therapy group（ group C） and goal-directed fluid therapy group（ group GDT）. Group C received perioperative fluid management based on MAP and CVP,while Group GDT received goal-directed fluid therapy based on SV and DO2 I optimization. MAP,HR,SV,and CI were recorded at different time points; the intraoperative blood loss,fluid volume,and urine volume were also recorded. Results The total fluid volume,colloid volume and crystal volume of group GDT were much more than group C（ P〈0. 05）; the intraoperative MAP,HR,SV,and CI in group GDT were much higher than group C（ P〈0. 05）; compared with baseline of MAP,HR,SV,and CI,there were no obvious change in group GDT,while there were significant decline in group C,especially after anesthesia and implantation of bone cements（ P〈0. 05）. Conclusion Compared with traditional fluid management strategy,SV and DO2 I optimization based goal-directed fluid therapy has a significant priority in high risk elderly patients undergoing total hip replacement. It can maintain better preload and provide more stable hemodynamic status,and prevent cardiac side effect induced by implantation of bone cements.

关 键 词：液体治疗 每搏量 氧供指数 优化 老年 高危 

分 类 号：R614[医药卫生—麻醉学]