目标导向治疗中每搏变异度对液体复苏患者的影响  

Effects of stroke volume variation on fluid resuscitation in goal-directed therapy for surgical patients with high risk

作　　者：高景利[1] 王爱田[1] 李晓岚[1] 刘慧燕[1] 张建军[1] 邵东风[1] 闫秀纵[1] 梁静涛[1] 马宇杰[1] 杨丽媛[1] 曹立瀛[1] 

机构地区：[1]华北理工大学附属开滦总医院,河北063000

出　　处：《中国急救复苏与灾害医学杂志》2016年第6期569-572,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：唐山市科技计划自筹经费项目（15130211a）

摘　　要：目的评价目标导向治疗（Goal—directed therapy，GDT）中每搏变异度（Stroke volume variation，svv）对液体复苏患者的影响。方法选择围手术期高风险的外科手术患者68例，随机分为两组，以SVV为指导的Vigileo治疗组（T组，n=32例）及对照组（c组，n=36例），术中液体复苏目标为维持SVV〈10％，统计术中补液量、发生低血压事件、术后乳酸水平及30d病死率、ICU住院天数及发生术后并发症情况。结果T组患者术中补胶体液量高于C组（1425±326mL vs 1136±408mL，P=0．002）；术中发生低血压事件两组比较无统计学差异；术后乳酸水平T组低于C组（1．78±0．83mmol／LVS2．25±1．12mmol／L，P=0．021）。T组中ICU住院天数（P=0．002）、患者发生术后并发症情况（P=0．012）均少于C组，两组比较有统计学差异。患者30d病死率两组比较无统计学差异（P〉0．05）。结论每搏变异度指导的目标导向治疗，能够使高风险外科手术患者术中血流动力学更加平稳，有效地指导液体复苏，降低术后患者的乳酸水平，能够改善组织灌注，减少术后并发症及感染的发生。Objective To investigate the effects of fluid rescucitation guided by stroke volume variation （SVV） on patients unedergoing major surgical procedures, such as major abdominal surgery, with high risk of anticipated operation time longer than 120 minutes. Methods Sixty eight adult patients of major abdominal surgery. Age 18-77, with the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity （POSSUM） ≥2 and the American Society of Anesthesiologists＇ Physical Status （ASA PS） ≥ Ⅱ-Ⅲ were randomly assigned to 2 groups： control group （Group C, n=36） ubdergoing general anaesthesia, tracheal intubation, mechanical ventilation, and arterial catheterization; and treatment group （Group T, n=32）, connecting to Vigileo monitor to record the mean arterial pressure （MAP）, central venous pressure （C VP）, heart rate （HR）, cardiac index （CI）, and CVV, in addition to above-mentioned measures. Results In Group T, the post-operative CVV, HR, and MAP values were all significantly lower than those pre-operatively （all P 〈0.05 or P 〈0.01）, and the post-operative CVP was significantly higher than that befor operation （P〈0.01）. In Gouup C there were not significant differences in CVP and HR velues between those pre- and post-operatively （both P 〉0.05）. The amount of intra-operative colloid fluid infusion of Group T was significantly higher than that of Groupo C （P =0.002）. The lactate level ih after the operation of Grouip T was significantly lower than that of Group C （P=0.021）. There was no difference in the number of hypotensive events in these 2 groups. Fewer Group T patients developed complications （P =0.012） . The length of ICU stay of Group T was （2 ±1.3）d, significantly shorter than that of Grou C [（3 ± 1.2）d, P =0.002]. There was no difference in the 30-day mortality between these 2 groups. Conclusion Goal-directed therapy guided by SVV during surgery for high risk patients helps maintain intra-operative hemo

关 键 词：每搏变异度 目标导向治疗 液体复苏 高风险患者 外科手术 

分 类 号：R364.1[医药卫生—病理学]