LiDCOrapid监测下目标导向血流动力学管理对老年胃肠手术患者术后转归的影响  

Effect of goal-directed hemodynamic management monitored by LiDCOrapid on postoperative outcomes of elderly patients undergoing gastrointestinal surgery

作　　者：张丁[1] 郑立山 刘芹 张琦[2] 陶清[1] ZHANG Ding;ZHENG Lishan;LIU Qin(Department of Anesthesiology,the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院麻醉科,合肥230031 [2]安徽中医药大学第一附属医院普外一科,合肥230031

出　　处：《安徽医学》2020年第3期257-260,共4页Anhui Medical Journal

基　　金：国家自然科学基金项目(项目编号:81403406)。

摘　　要：目的观察LiDCOrapid监测下目标导向血流动力学管理对老年胃肠手术患者术后转归的影响。方法选择2018年2月至2019年7月入住安徽中医药大学第一附属医院的90例胃肠手术患者,采用随机数字表法分为LiDCOrapid监测下目标导向血流动力学管理组(L组)与经验麻醉组(E组),每组45例。L组采用LiDCOrapid监护仪监测心脏指数(CI)、每搏量变异率(SVV),以SVV(≤12%)、CI[≥2.5 L/(min·m^2)]、平均动脉压(维持在基础值±20%)为目标,调整补液和心血管药物的使用;E组仅凭医师临床经验实施血流动力学管理。记录术中血流动力学相关指标,以及术后恢复和相关并发症发生情况。结果L组患者术中液体输注总量为(859.16±178.61)mL、尿量为(257.83±149.22)mL,均少于E组,差异有统计学意义(P<0.05)。L组患者术后拔管时间和麻醉苏醒室留观时间分别为(25.29±10.63)min和(40.44±10.12)min,短于E组,差异有统计学意义(P<0.05)。L组患者术后首次通气时间、住院时间分别为(4.35±1.47)d和(11.91±1.89)d,均短于E组,差异有统计学意义(P<0.05)。L组患者术后第24小时血乳酸为(0.86±0.29)mmol/L,低于E组,差异有统计学意义(P<0.05)。结论LiDCOrapid监测下的目标导向血流动力学管理,能够减少老年胃肠手术患者术中输液总量,加快术后胃肠功能恢复,缩短住院时间。Objective To observe the influence of goal-directed haemodynamic management monitored by LiDCOrapid on the postoperative outcomes in elderly patients undergoing gastrointestinal surgery.Methods Ninety patients admitted to the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine with gastrointestinal surgery were selected during February 2018 and July 2019.The patients were randomly divided into two groups(n=45):goal-directed hemodynamic management based on LiDCOrapid group(group L,n=45)and experience anesthesia group(group E,n=45).In group L,the SVV and CI were monitored by LiDCOrapid,and fluid infusion and the use of vasoactive agent were adjusted according to SVV(≤12%),CI[≥2.5 L/(min m 2)]and MAP(maintain the base value of±20%).In group E,fluid and vasoactive agent were used according to the experience of anesthesiologists.The hemodynamic parameters during operation and the incidence of postoperative complications were recorded.Results The gross volume of the total fluid infusion and urine of group L was(859.16±178.61)mL and(257.83±149.22)mL respectively,which was less than that in group E(P<0.05).Extubation time[(25.29±10.63)min],PACU discharge time[(40.44±10.12)min],time to first exhaust[(4.35±1.47)days]and length of hospitalization[(11.91±1.89)days]in group L were shorter than those in group E(P<0.05).And the lactic acid value of 24 hours after surgery in group L[(0.86±0.29)mmol/L]was lower than that in group E(P<0.05).Conclusions Goal-directed haemodynamic management monitored by LiDCOrapidcould reduce total fluid infusion,accelerate recovery of gastrointestinal function and shorten the time of hospitalization in elderly patients undergoing gastrointestinal surgery.

关 键 词：胃肠手术 血流动力学 老年人 术后并发症 

分 类 号：R656[医药卫生—外科学]