每搏变异度指导目标导向液体管理在幕上肿瘤切除术中的应用  

Application of fluid management under the guidance of stroke volume variation in patients undergoing supratentorial neoplasms surgery

作　　者：吴洁[1] 马艳辉[1] 张瑛[1] 范隆[1] 王天龙[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京市100053

出　　处：《临床麻醉学杂志》2017年第5期425-429,共5页Journal of Clinical Anesthesiology

摘　　要：目的评价每搏变异度(stroke volume variation,SVV)指导的目标导向治疗(goal-directed therapy,GDT)液体管理策略与CVP指导的液体管理策略对行幕上脑肿瘤切除术患者的影响。方法选择择期全麻下行幕上脑肿瘤切除术患者63例,男29例,女34例,年龄18~65岁,ASAⅠ或Ⅱ级,按照随机数字表法分为C组(n=30)和S组(n=33)。所有患者入室后输注6%羟乙基淀粉(130/0.4)3ml/kg,随后每小时按生理需要量持续输注生理盐水。通过输注6%羟乙基淀粉(130/0.4)或给予血管活性药物,C组维持CVP≥8mm Hg且MAP>基础值的80%,S组维持SVV≤12%且MAP>基础值的70%。记录术中晶体液量、胶体液量、总输液量、失血量、输血量和尿量,于麻醉诱导前30min(T0)、剪硬膜即刻(T1)、术毕(T2)和术后24h(T3)采集桡动脉和静脉血行血气分析、乳酸测定和生化检查。记录术后患者心律失常、低血压、肝功能异常、肾功能异常和严重呕吐等并发症的发生情况。记录ICU停留时间及术后住院时间。结果S组术中总液量[(1 478±312)ml vs(1 183±294)ml]及胶体液量[(775±236)ml vs(487±243)ml]明显多于C组(P<0.05)。与T0时比较,T1、T2时两组乳酸值均明显降低(P<0.05);T2时S组乳酸值明显低于C组[(0.91±0.25)mmol/L vs(1.31±0.46)mmol/L](P<0.05)。两组心律失常、低血压和严重呕吐发生率差异无统计学意义。两组ICU停留时间和术后住院时间差异无统计学意义。结论 SVV指导目标导向液体管理可降低术毕乳酸水平。Objective To evaluate the effects of arterial pressure continuous output （APCO） derived from stroke volume variation （SVV）-guided fluid management in the patients undergoing su- pratentorial neoplasms surgery. Methods Sixty-three patients （29 males, 34 females, aged 18-65 years, ASA physieal status Ⅰ or Ⅱ ） undergoing elective supratentorial neoplasma surgery were ran- domly divided into control group （group C, CVP-guided fluid management, n = 30） and GDT group （group S, SVV-guided fluid management, n =33）. Before the induction of general anesthesia, the hydmxyethyl starch Voluven （130/0. 4） bolus 3 ml/kg in the two groups was administered followed by infusion of erystalloid at the rate of physical requirement. Hydroxyethyl starch or vasoaetive agents were administrated to achieve the goal of CVP≥8 mm Hg or MAP〉80% of baseline in group C and- to reach the value of SVV≤12% and MAP〉70% of baselinein group S. Intraoperativecrystal, intra- operative colloids, total fluid volume, bleeding volume, volume of blood transfusion and urine volume were recorded. The radial artery and venous blood was sampled for blood gas analysis, measurement of lactate concentration and laboratory parameters at 30 min before anesthesia induction （To）, the du- ra mater cutted （T1）, end of operation （T2） and postoperative 24 h （T3）. Postoperative complications and the number of patients with complications in postoperative period, the length of ICU stay and postoperative days were assessed. Results Total infused fluid volume [（1 478± 312） ml vs （1 183±294） ml] and intraoperative colloids [（775±236） ml vs （487±243） ml] were signifi- cantly higher in group S than those in group C （P〈0.05）. Compared with To, the lactate concentra- tion were decreased significantly in two groups at T1 and T2. The lactate concentration in group S was significantly lower than group C at T2 [（0.91± 0. 25） mmol/L vs （1.31 ±0.46） mmol/L] （P〈0. 05）. There was no significant di

关 键 词：神经外科手术 目标导向治疗 每搏变异度 术后并发症 

分 类 号：R614[医药卫生—麻醉学] R739.4[医药卫生—外科学]