以每搏量变异度指导外科术后低血容量患者 进行液体复苏的临床研究  

Clinical effect of fluid resuscitation guided by stroke volume variation for postopertative hypovolemic patients

作　　者：司向[1] 吴健锋[1] 陈娟[1] 陈敏英[1] 刘紫锰[1] 刘勇军[1] 管向东[1] 

机构地区：[1]中山大学附属第一医院SICU,广东广州,510080

出　　处：《中华危重病急救医学》2016年第11期1014-1018,共5页Chinese Critical Care Medicine

基　　金：广东省重大科技专项基金（2012A080204018）;国家临床重点专科建设项目（2011-872）

摘　　要：目的：探讨以每搏量变异度（SVV）＜10%为目标指导外科术后低血容量患者进行液体复苏的有效性。方法采用前瞻性单盲随机对照研究，纳入2011年4月至2014年2月中山大学附属第一医院外科重症加强治疗病房（SICU）连续收治的外科术后SVV＞10%的低血容量患者，并按计算机产生的随机数字表将患者分为SVV组和中心静脉压（CVP）组，分别以SVV＜10%及CVP10～12mmHg（1mmHg＝0.133kPa）为目标进行液体复苏，并于6h内达标。主要观察指标为复苏达标时的组织氧代谢和血流动力学指标；次要观察指标为复苏达标时的液体复苏情况及心肺并发症发生率。结果共入组62例患者，SVV组32例，CVP组30例。两组患者入组时基线资料、血流动力学、组织氧代谢指标差异均无统计学意义，具有可比性。两组患者液体复苏达标时组织氧代谢、血流动力学指标均明显改善；且与CVP组比较，SVV组复苏后血红蛋白〔Hb（g/L）：102.6±23.4比87.9±16.0〕、氧输送〔DO2（mL/min）：944.6±399.4比727.3±183.6〕、平均动脉压〔MAP（mmHg）：98.9±15.7比89.8±9.9）、每搏量指数〔SVI（mL/m2）：51.8±19.5比41.4±11.3〕进一步升高（均P＜0.05），CVP进一步下降（mmHg：8.3±4.4比12.2±2.0，P＜0.05）；SVV组液体复苏达标所需时间明显缩短（h：1.4±0.6比3.8±1.4，t＝6.415，P＝0.000），复苏液体量（mL：611.4±453.0比1476.4±741.2，t＝4.216，P＝0.000）、液体平衡量（mL：366.0±290.8比942.3±532.1，t＝4.010，P＝0.001）明显减少，复苏中输入红细胞量差异无统计学意义〔mL：0（0，7.0）比0（0，87.5），U＝-1.624，P＝0.352〕。SVV组心肺并发症发生率较CVP组明显降低（0比13.3%，χ2＝4.564，P＝0.033）。结论在外科术后早期以SVV＜10%为目标指导液体复苏能明显提高患者的DO2，改善其血流动力学状态，从而有利于尽快纠正患者的低血容量状态，防止器�Objective To discuss the effect of fluid resuscitation guided by stroke volume variation （SVV） 〈 10% in postoperative hypovolemic patients. Methods A prospective single-blinded randomized controlled trial （RCT） was conducted. Postoperative hypovolemic patient with SVV 〉 10% admitted to Department of Surgical Intensive Care Unit （SICU） of First Affiliated Hospital of Sun Yat-Sen University from April 2011 to February 2014 were enrolled. The patients were divided into SVV group and central venous pressure （CVP） group by random number table, fluid resuscitation targeted by SVV 〈 10% and CVP 10-12 mmHg （1 mmHg = 0.133 kPa） respectively were performed within 6 hours. The primary end-points included tissue oxygen metabolism and hemodynamics as the goal of fluid resuscitation was arrived. The secondary end-points included resuscitation results and the incidence of cardiopulmonary complication as the goal of fluid resuscitation was arrived. Results A total of 62 patients were enrolled, with 32 patients in SVV group and 30 in CVP group. There was no significant difference in the baseline, hemodynamic and tissue oxygen metabolism parameters between the two groups with comparability. The tissue oxygen metabolism and hemodynamic parameters were significantly improved as the goal of fluid resuscitation was arrived. Hemoglobin [Hb （g/L）： 102.6±23.4 vs. 87.9±16.0], oxygen delivery [DO2 （mL/min）： 944.6±399.4 vs. 727.3±183.6], mean artery pressure [MAP （mmHg）： 98.9±15.7 vs. 89.8±9.9] and stroke volume index [SVI （mL/m2）： 51.8±19.5 vs. 41.4±11.3] after resuscitation in SVV group were significantly higher than those of CVP group （all P 〈 0.05）, and CVP was significantly lower than that of CVP group （mmHg： 8.3±4.4 vs. 12.2±2.0, P 〈 0.05）. Resuscitation time （hours： 1.4±0.6 vs. 3.8±1.4, t = 6.415, P = 0.000）, resuscitation fluid （mL： 611.4±453.0 vs. 1 476.4±741.2, t = 4.216, P = 0.000） and fluid balance （mL： 366.0±290.8 vs. 942.3±532.1, t

关 键 词：术后 低血容量 液体复苏 每搏量变异度 血流动力学 组织氧代谢 

分 类 号：R459.7[医药卫生—急诊医学]