老年患者围术期容量管理方式及检测指标的探讨  

Option and monitoring measures of perioperative volume management in elderly patients

作　　者：王孝茹[1] 原大江[1] Wang Xiaoru;Yuan Dajiang(Department of Critical Care Medicine,Second Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院重症医学科,太原030001

出　　处：《中国药物与临床》2020年第6期900-903,共4页Chinese Remedies & Clinics

摘　　要：目的 评价围术期容量精细化管理对老年手术患者预后的影响及容量管理监测指标的有效性。方法 将86例受试者按随机数字表法分试验组和对照组,每组43例。试验组采用围术期容量精细化管理,对照组采用常规输液管理。比较2组受试者的气管插管时间、重症监护室(ICU)停留时间、28 d非ICU住院时间以及液体出入量,及术前1 d、术后入室时、术后2 h及术后24 h氧合指数、N末端-B型利钠肽前体(NT-proBNP)及乳酸水平的变化情况。结果 与对照组比较,试验组ICU停留时间明显缩短,28 d内非ICU住院时间明显延长,液体出量、入量及出入量差值明显减少,2组比较差异有统计学意义(P<0.05)。2组受试者术前1 d各个检测指标比较差异无统计学意义(P>0.05)。术后入室时,与对照组比较,试验组氧合指数明显升高(P<0.05),NT-proBNP及乳酸水平均明显降低(P<0.05)。术后2 h及术后24 h,与对照组比较,试验组NT-proBNP及乳酸均明显降低(P<0.05),氧合指数明显升高(P<0.05)。结论 围术期容量精细化管理是适用于老年患者的一种安全有效、预后良好的液体管理方式,而氧合指数、NT-proBNP及乳酸是操作简便、可重复性强的适用于围术期容量精细化管理的监测指标,具有临床推广应用的意义。Objective To evaluate the impact of perioperative volume delicacy management on the surgical outcome and effectiveness of monitoring indicators for the volume management in elderly patients.Methods A total of 86 subjects were randomly divided into the study group and control group(n=43 each).Perioperative volume delicacy management was used in the study group,and conventional infusion management was used in the control group.The two groups were compared for endotracheal intubation time,length of ICU stay,28-day non-ICU hospital stay,fluid input and output,oxygenation index(OI),NT-proBNP and lactic acid levels at 1 day before surgery,immediately at postoperative arrival to wards,2 hours and 24 hours after surgery.Results Compared with the control group,the study group showed significantly shorter ICU stay,longer non-ICU hospital stay,less fluid output,input and output-input difference,with statistically significant differences(P<0.05).There was no statistically significant difference between the two groups in all monitoring measures at 1 day before surgery(P>0.05).At postoperative arrival to wards,compared with the control group,the study group showed increased OI(P<0.05),and lowered levels of NT-proBNP and lactic acid(P<0.05).At 2 hours and 24 hours after operation,compared with the control group,the study group showed significantly reduced NT-proBNP and lactic acid levels(both P<0.05),and higher OI(P<0.05).Conclusion Delicacy management of perioperative volume is a safe,effective,and well-prognostic fluid management option for elderly patients.The OI,NT-proBNP,and lactic acid are simple and reproducible monitoring measures for perioperative volume delicacy management,which justifies their widespread use in clinical settings.

关 键 词：髋骨折 老年人 围术期医护 

分 类 号：R473.6[医药卫生—护理学]