目标导向液体治疗对肝癌手术患者短期预后的影响  

Effects of goal-directed fluid therapy on short-term prognosis of patients undergoing liver cancer surgery

作　　者：刘超[1] 邹亮[1] Liu Chao;Zou Liang(Department of Anesthesiology,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]中国医学科学院肿瘤医院麻醉科

出　　处：《北京医学》2019年第12期1083-1085,共3页Beijing Medical Journal

摘　　要：目的探讨应用每搏量变异度(stroke volume variation, SVV)进行目标导向液体治疗(goal-directed fluid therapy, GDFT)对肝癌手术患者术后恢复的影响。方法选择2018年8月1日至2019年5月1日中国医学科学院肿瘤医院行择期肝脏手术的肝癌患者,随机分为实验组(SVV组)和对照组(central venous pressure, CVP组)。SVV组:恒速缓慢输注乳酸林格液补充生理需要量2 ml/(kg·h),若患者SVV值>9,则在5 min内予50 ml羟乙基淀粉130/0.4快速输注,观察SVV值变化;若SVV值仍>9,则重复给予直至SVV<9。CVP组:按照经典补液方案进行液体治疗,若术中MAP<基础值的80%,且CVP<8 mmHg(1 mmHg=0.133 k Pa),则在5 min内予50 ml羟乙基淀粉130/0.4快速输注。记录术中出入量、手术时间,术后3 d的AST、ALT、SCr、BUN,排气时间及术后住院日。结果实验组术后肝功能、排气时间及术后住院日与对照组比较差异均无统计学意义;实验组术后第1天SCr高于对照组,但术后第2、3天的SCr组间比较差异无统计学意义。结论 GDFT对肝癌患者术后肝肾功能、排气时间及术后住院日等短期预后指标无影响。Objective To investigate the effect of stroke volume variability(SVV) guided fluid therapy on postoperative recovery of patients undergoing liver cancer surgery. Methods Sixty patients undergoing liver surgery in Cancer Hospital of Chinese Academy of Medical Sciences were randomly divided into experimental group(SVV group) and control group(CVP group). In SVV group, lactate ringer solution was slowly infused with speed of 2 ml/(kg· h). If the SVV > 9, 50 ml hydroxyethyl starch 130/0.4 was given within five min to observe the change of SVV. If SVV was still > 9, it was repeated until SVV < 9. In CVP group, liquid therapy was performed according to the classical fluid supplementation scheme. If MAP <80% of the basic value and CVP < 8 mm Hg, 50 ml hydroxyethyl starch 130/0.4 was given within five min. Intraoperative intake and output, operation time, AST, ALT, SCr, BUN, exhaust time and postoperative hospital stay were recorded. Results There were no statistically significant difference in postoperative liver function, exhaust time and postoperative hospital stay between two groups. The SCr of the SVV group was significant higher than that of the CVP group on the first day after surgery, but there was no significant difference between the two groups on the second day and the third day after surgery. Conclusions Goal-directed fluid therapy can not improve the short-term prognosis of liver cancer patients after operation, including liver function, exhaust time and postoperative hospital stay.

关 键 词：目标导向液体治疗 每搏量变异 肝癌手术 

分 类 号：R61[医药卫生—外科学]