高龄病人围手术期血容量的目标导向管理  

The management of goal- directed fluid therapy in elderly patients' s perioperative period

作　　者：尹学军[1] 宁贤友[1] 谢卫农[1] 毕经斌[1] 

机构地区：[1]合肥市第八人民医院麻醉科,安徽省238000

出　　处：《当代临床医刊》2016年第3期2177-2179,共3页Journal of Contemporary Clinical Medicine

基　　金：安徽省合肥市科技局科技计划项目(编号:2012-46)

摘　　要：目的探讨目标导向液体治疗在高龄患者手术中的应用。方法择期行手术治疗的高龄患者80例,ASAⅡ或Ⅲ级,男,54例,女,26例,年龄75~92岁,随机分为目标导向治疗组(G组)和经典输液治疗组(C组)。局麻下行桡动脉穿刺及颈内静脉穿刺,监测BP、CVP。桡动脉连接Flotrac/Vigileo监测系统监测每搏变异度(SVV)、CI等指标。G组根据SVV、MAP、CI、心搏量指数(SVI)将CI≥2.6L·min^(-1)·m^(-2)、SVV≤12作为目标行目标导向液体治疗,C组根据CVP及MAP行经典补液治疗。记录手术时间、晶体液量、胶体液量、尿量及出血量。记录入室建立监测后(T1)、诱导后即刻(T2)、手术开始即刻(T_3)、手术开始后1h(T_4)、术毕(T_5)的MAP、HR、CVP、CI、SVV的变化。检测T_3、T_5时的SaO_2、ScvO_2及血乳酸含量并计算术中氧供指数(DO_2I)、氧耗指数(VO_2I)、氧摄取率(ERO_2)、不良反应(恶心呕吐、认知障碍)的发生率和胃肠通气时间。结果与C组比较G组胶体液输注量和尿量明显增加(P<0.05),T_3、T_4时G组CI明显升高(P<0.05),T3、T4时SVV明显降低(P<0.05)。与C组比较,T_5时G组ScvO_2、DO_2I、VO_2I、ERO_2均明显增加(P<0.05),血乳酸浓度明显降低(P<0.05),不良反应明显降低(P<0.05),胃肠通气时间缩短(P<0.05)。结论目标导向液体治疗能有效优化择期手术中高龄患者的心脏前负荷,提高心输出量,保证微循环灌注,维持机体氧供需平衡,提供比经典液体治疗方案更好的容量治疗,同时能降低副反应的发生率。Objective To evaluate the application of goal - directed fluid therapy in elderly patients undergoing surgery. Methods Sixty patients（54 male,26 female,ASAII or ]lI ,70 -92 years old）undergoing selective surgery were included and randomly divided into two groups base on treatment ： goal - directed fluid therapy （ group G） and conventional fluid therapy （group C）. Implementing radial artery puncture and internal jugular vein punc- ture under local anesthesia in order to monitor blood pressure（BP） and central venous pressure（CVP） , The Flotrac/Vigileo system was used to obtain stroke volume variation （SVV） and cardiac index （CI）. As mentioned above. group C receive conventional fluid therapy based on CVP and MAP , whereas group G receive goal - directed fluid therapy based on SVV,MAP,SVI and CI with the goal of CI no less than 2.5L· min^-1 · m^-2. The duration of surgery, crystalloid requirements, urinary output and bleeding volume were recorded. The variation of MAP, HR, CVP, CI and SVV at the onset of the monitoring（ T1 ） , the moment after anesthesia induction （ T2 ） , the beginning of surgery （T3 ） , one hour after surgery （T4 ）and the end of the surgery （T5 ） were recorded. SaO2 ,ScvO2 and lactic acid content were examined at T3 and T5. The index of oxygen delivery（ DO2 I） , index of oxygen consumption （VO2 I） oxygen extraction ratio（ ERO2 ） ,the incidence of adverse reactions（ PONV ,COPD） ,gastrointestinal ventilation time were calculated. Results The colloid volume and urinary output in group G was higher than that in group C（ P 〈 0.05 ）. CI at T3 and T4 in group G was higher than that in group C （ P 〈 0.05 ）, while SVV at T2 and T3 in group G was lower than in group C（）. cvO2 ,DO2 I,VO2 I,ERO2 at T5 in group G were higher than that in group C （P 〈 0. 05 ）. The concentration of lactic at T5 in group G was lower than that in group C （ p 〈 0.05 ）. the incidence of adverse reactions was lower than that in group C （

关 键 词：目标导向液体治疗 高龄老人 手术 血容量 

分 类 号：R614[医药卫生—麻醉学]