Flotrac监测在诱导期预扩容血流动力学和目标导向液体治疗中的应用  

Flotrac System for Monitoring Hemodynamic Response to Volume Expansion before Induction of Anesthesia and Goal-directed Fluid Therapy

作　　者：万玉骁 魏巍 朱俊超[1] WAN Yuxiao;WEI Wei;ZHU Junchao(Department of Anesthesiology,Shengjing Hospital,China Medical University,Shenyang 110004,China;Department of Anesthesiology,Northeast International Hospital,Shenyang 110623,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004 [2]东北国际医院麻醉科,沈阳110623

出　　处：《中国医科大学学报》2018年第4期316-320,共5页Journal of China Medical University

基　　金：辽宁省自然科学基金(20102282)

摘　　要：目的 比较等渗氯化钠羟乙基淀粉溶液万汶(VOL)与乳酸林格氏液(LR)预扩容对老年胃肠道肿瘤手术患者术中血流动力学的影响。方法 选择拟行胃肠道手术的老年患者40例,随机分为万汶组(V组)和林格组(R组),每组各20例,均于术中行全身麻醉。V组患者在进入手术室后行VOL 7 mL/kg静脉滴注,而R组患者在进入手术室后行LR 7 mL/kg静脉滴注,输液速度控制在10~15 mL/min。应用无创心排血量(Flo Trac)监测仪分别记录输液前(T0)、输液后(T1)、诱导完成(T2)、诱导完成后3 min(T3)、插管完成(T4)、插管完成后5 min(T5)、插管完成后10 min(T6)时患者的血压(SBP/DBP)、心率(HR)、心输出量(CO)、心指数(CI)、中心静脉压(CVP)、每搏指数(SVI)、外周血管阻力指数(SVRI)值的变化,且通过术中全程监测患者每搏量变异度(SVV)来指导术中输液速度及液体量。结果 2组SBP、CO、CI、SVI于诱导及插管后均呈下降趋势,差异有统计学意义(P<0.05);DBP、HR、CVP于诱导时下降而插管时升高,差异有统计学意义(P<0.05);2组SVRI于T4、T5、T6观察点均有升高,差异有统计学意义(P<0.01)。以SVV作为衡量术中输液的指标,R组患者的术中入液量及术程中总尿量均明显高于V组(P<0.01)。结论 在全麻患者诱导前,给予VOL预扩容与给予LR相比,其诱导期患者的血流动力学更稳定,并能显著减少术中入液量,降低患者循环容量超负荷的风险。Objective To compare the effects of two volume pre-expansion methods,namely that using 6%hydroxyethyl(Voluven,VOL)and that using lactated Ringer’s solution(LR),on perioperative hemodynamic changes within elderly patients who underwent gastrointestinal neoplastic discharge.Methods Forty elderly patients aged 60 to 75 years who underwent gastrointestinal neoplastic operation were selected.These patients were randomly divided into two groups(R and V)according to American Society of Anesthesiologists’(ASA)Physical Status Classification System gradesⅠandⅡ.Thereinto,20 patients were assigned in each group to receive either lactated Ringer’s solution 7 mL/kg or 6%hydroxyethyl 7 mL/kg(10 to 15 mL/min).Cardiac function,including blood pressure(BP),heart rate(HR),cardiac index(CI),central venous pressure(CVP),stroke volume index(SVI),cardiac output(CO),system vascular resistance index(SVRI),and stroke volume variation(SVV),was monitored using the Vigileo/FloTrac system(Edwards Lifesciences,Irvine,CA).Monitoring and recording in each group were performed at 7 time points as follows:T0(5 minutes after admission to the operating room),T1(after volume infusion),T2(immediately after induction),T3(3 min after induction),T4(during intubation),T5(5 min after intubation),and T6(10 min after intubation).Results During the induction period and after the intubation period,systolic blood pressure,CO,CI,and SVI were markedly decreased,with significant differences between the two groups(P<0.05).Diastolic blood pressure,HR,and CVP were associated with a decreased trend during the induction period and associated with an increased trend after the intubation period(P<0.05,respectively).The peripheral vascular resistance index(SVRI)showed a significant increase after the intubation period,from T4 to T6,with a significant difference between the two groups(P<0.01).Intraoperative infusion and urine volumes were significantly higher in the R group than in the V group(P<0.01).Conclusion The effect of preinduction volume expansion with 6%

关 键 词：预扩容 等渗羟乙基淀粉溶液 血流动力学 每搏量变异度 

分 类 号：R614.2[医药卫生—麻醉学]