老年手术患者不同水平每搏量变异度指导液体治疗方案对短期预后影响研究  

Effects of different levels of stroke volume variation directed fluid therapy on short term of prognosis in elderly surgery patients

作　　者：胡素颖[1] 朱元嵩 徐康清[2] Hu Suying Zhu Yuansong Xu Kangqing(Department of Anesthesiology, the First People＇s Hospital of Shunde District Foshan City, Guangdong Foshan 528300, Chin)

机构地区：[1]广东省佛山市顺德区第一人民医院麻醉科,528300 [2]中山大学附属第一医院麻醉科

出　　处：《中国医师进修杂志》2017年第1期63-67,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：探讨老年手术患者以不同水平的每搏量变异度（SVV）指导液体治疗方案对预后的临床意义。方法选择施行腹部手术的老年患者156例，ASA分级Ⅰ～Ⅱ级。将患者按不同SVV水平进行分组：低SVV组（SVV 3%～6%）、中SVV组（SVV 7%～10%）及高SVV组（SVV 11%～14%），每组52例，按分组不同水平SVV实施不同液体治疗方案。比较三组术中相关指标、术后恢复指标及术后相关并发症。结果低SVV组和中SVV组晶体输入量及胶体输入量明显高于高SVV组[（2365±517）和（2080±378）ml比（1820±579）ml、（1105±220）和（898±239） ml比（559±166）ml]，而且低SVV组明显高于中SVV组，差异有统计学意义（P＜0.05）；低SVV组尿量明显多于高SVV组[（717.4±289.0）ml比（511.8±326.3）ml]，差异有统计学意义（P＜0.05）。高SVV组首次排气时间明显短于低SVV组[（81.2±27.5）h比（98.9±32.5）h]，差异有统计学意义（P＜0.05）；中SVV组一级及以上护理时间、术后住院时间和总住院时间均明显短于高SVV组和低SVV组[（4.4±2.8）d比（5.3±3.2）和（6.4±3.7）d、（13.8±5.2）d比（17.7±8.4）和（19.5±8.9）d、（22.7±10.4）d比（26.8±13.1）和（30.6±10.3）d]，差异有统计学意义（P＜0.05）。高SVV组吻合口漏发生率明显高于低SVV组[17.3%（9/52）比3.8%（2/52）]，高SVV组和中SVV组术后感染发生率明显低于低SVV组[5.8%（3/52）和5.8%（3/52）比26.9%（14/52）]，差异有统计学意义（P＜0.05）。结论老年手术患者以SVV 3%～6%可能会使术后感染风险增高并延长住院的时间；而SVV 7%～10%则可能会使患者恢复的质量更好，可作为围手术期指导液体治疗方案的最佳水平。Objective To observe the effects of different levels of stroke volume variation（SVV） directed fluid therapy on prognosis in elderly surgery patients. Methods One hundred and fifty-six patients （ASA gradeⅠorⅡ） having underwent abdominal surgery were selected, and the patients were divided into 3 groups according to the level of SVV with 52 cases each：low SVV group （SVV 3%-6%）, middle SVV group （SVV 7% - 10%） and high SVV group （SVV 11% - 14%）. Each group accepted different fluid therapy strategy. The intraoperative index, postoperative recovery index and complications were compared. Results The volume of crystalloid and volume of colloform in low SVV group and middle SVV group were significantly higher than those in high SVV group： （2 365 ± 517） and （2 080 ± 378） ml vs. （1 820 ± 579） ml, （1 105 ± 220） and （898 ± 239） ml vs. （559 ± 166） ml, and those in low SVV group were significantly higher than those in middle SVV group, and there were statistical differences （P〈0.05）. The urine volume in low SVV group was significantly higher than that in high SVV＆nbsp;group：（717.4 ± 289.0） ml vs. （511.8 ± 326.3） ml, and there was statistical difference （P〈0.05）. The first exhaust time in high SVV group was significantly shorter than that in low SVV group：（81.2 ± 27.5） h vs. （98.9 ± 32.5） h, and there was statistical difference （P〈0.05）. The first level and above nursing time, postoperative hospital stay and total length of hospital stay in middle SVV group were significantly shorter than those in high SVV group and low SVV group： （4.4 ± 2.8） d vs. （5.3 ± 3.2） and （6.4 ± 3.7） d, （13.8 ± 5.2） d vs. （17.7 ± 8.4） and （19.5 ± 8.9 ） d, （22.7 ± 10.4） d vs. （26.8 ± 13.1） and （30.6 ± 10.3） d, and there were statistical differences （P〈0.05）. The incidence of stomal leak in high SVV group was significantly higher than that in low SVV group： 17.3% （9/52） vs. 3.8% （2/52）, the i

关 键 词：老年人 每搏输出量 预后 液体治疗 

分 类 号：R614[医药卫生—麻醉学]