每搏量变异度指导的目标导向液体治疗对胃肠肿瘤患者术中、术后胃肠功能的影响  

Effect of goal-directed fluid therapy guided by SVV on gastrointestinal function in patients undergoing resection of gastrointestinal tumor

作　　者：丁妮 张冬梅[2] 高玉华[2] 徐向钊 郎淑慧[2] 王海滨[2] 

机构地区：[1]宁夏医科大学临床医学院,银川市750004 [2]宁夏医科大学总医院麻醉科 [3]宁夏回族自治区第五人民医院麻醉科

出　　处：《临床麻醉学杂志》2018年第1期45-49,共5页Journal of Clinical Anesthesiology

基　　金：宁夏回族自治区科技支撑计划项目

摘　　要：目的探讨基于每搏量变异度(SVV)指导的目标导向液体治疗(goal-directed fluid therapy,GDFT)对胃肠肿瘤手术患者术中、术后胃肠功能的影响。方法选取2016年1月至2017年2月择期行胃肠道肿瘤根治术患者60例,男31例,女29例,年龄60~85岁,ASAⅡ或Ⅲ级,采用随机数字表法将患者分为以中心静脉血氧饱和度(ScvO_2)指导的液体治疗组(C组,n=30)和以SVV指导的目标导向液体治疗组(G组,n=30)。记录麻醉诱导前(T_0)、肿瘤摘除即刻(T_1)、术毕(T_2)和术后6h(T_3)时动、静脉血pH、BE、HCO_3^-、Lac。抽取T_0、T_3时静脉血测定脂多糖(LPS)、降钙素原(PCT)的浓度。记录术中所输注的晶体液量、胶体液量、总液量、出血量、腹腔冲洗液量、多巴胺使用率等。记录患者术后PACU时间、术后排气、进食及住院时间。结果 T_2、T_3时G组动脉血BE明显高于C组,T_2时动脉血Lac、T_3时动/静脉血Lac明显低于C组(P<0.05);T_3时G组LPS、PCT明显低于C组(P<0.05);G组胶体液输注量明显多于,晶体液输注量和总液量明显少于C组(P<0.05);G组术后PACU时间、排气时间、进食时间、术后住院时间明显短于C组(P<0.05)。结论对于行胃肠肿瘤手术患者,采用以SVV指导的目标导向液体治疗更有利于维持患者的酸碱平衡,降低感染的发生率,促进术后胃肠功能的恢复,减少住院时间。Objective To investigate the effect of SVV guided fluid therapy on blood gas and lipopolysaccharide（LPS）,procalcitonin（PCT）in patients undergoing resection of gastrointestinal tumor.Methods Sixty patients aged 60-85 years from Jan,2016 to Feb,2017 falling into ASA physical statusⅡ orⅢ,scheduled for elective radical operations for gastrointestinal cancers,were included and randomly divided into two groups（n=30 each）using a random number table：ScvO_2 guided fluid therapy（group C）,SVV guided fluid therapy（group G）.MAP,HR and CVP of patients were recorded at the same time before anesthesia（T_0）,tumor removal（T_1）and the end of surgery（T_2）respectively.PH,BE,HCO-3 and Lac of venous blood samples and artery blood samples at T_0-T_2,6 hours after surgery（T_3）were recorded.Venous blood samples were collected at T_0,T_3 to detect LPS and PCT.Crystalloid requirements,colloid requirements,total volume,bleeding volume,peritoneal fluid volume and the use of dopamine were recorded.The time of PACU,time when the patients first exhausted and was fed after operation,length of hospital stay after operation were recorded.Results Compared with group C,BE of artery blood was obviously increased at T_2,T_3 in group G（P0.05）;the Lac of artery at T_2 and the Lac of artery and venous blood at T3 in group G was obviously decreased.LPS and PCT were decreased at T_3 in group G（P0.05）.Compared with group C,the needed colloid was increased in group G,the needed crystalloid and total volume of fluid infused were decreased in group G（P0.05）.Compared with group C,the time of PACU starting to exhaust and feed,length of hospital was shortened in group G（P0.05）.Conclusion SVV guided goal directed fluid therapy is more conductive to maintain the acid-base and reduce the incidence of infection for the patients with gastrointestinal tumor operation,promote the recovery of gastrointestinal function and decrease the length of hopital after operations.

关 键 词：目标导向液体治疗 胃肠肿瘤 动静脉血气 脂多糖 降钙素原 胃肠功能 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]