以脉压变异率为目标导向的液体治疗在开腹肝脏手术中的应用效果  

Application effect of goal-directed fluid therapy using pulse pressure variation in open liver surgery

作　　者：梁超琴 张光英[2] 林成新[2] 陈小云 LIANG Chao-qin;ZHANG Guang-ying;LIN Cheng-xin;CHEN Xiao-yun(Department of Anesthesiology,Wuming Hospital Affiliated to Guangxi Medical University,Nanning 530199,China;Department of Anesthesiology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属武鸣医院麻醉科,武鸣530199 [2]广西医科大学第一附属医院麻醉科,南宁市530021

出　　处：《广西医学》2021年第2期155-159,共5页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z20190872)。

摘　　要：目的探讨以脉压变异率(PPV)为目标导向的液体治疗在开腹肝脏手术中的应用效果。方法将90例择期行开腹肝脏手术的患者随机分为对照组、PPV1组和PPV2组,每组30例。3组患者均采用气管插管全身麻醉,对照组采用控制性降低中心静脉压技术指导液体管理;PPV1组、PPV2组均采用以PPV为目标导向的液体治疗,其中PPV1组将PPV维持在<10%水平,PPV2组将PPV维持10%~15%水平。记录3组患者肝门阻断前后的平均动脉压(MAP)和心率;记录3组患者术中晶体液及胶体液的输入量、输液总量、出血量、血管活性药物使用情况及术后恶心呕吐、肺部感染、胃肠道功能恢复情况。结果肝门阻断后,3组患者的MAP均较阻断前降低,心率均较阻断前升高(P<0.05),对照组MAP下降的幅度及心率升高的幅度最大,其次是PPV2和PPV1组(均P<0.05)。3组患者晶体液输入量、输液总量差异有统计学意义,对照组、PPV2组、PPV1组的晶体液输入量及输液总量依次升高(均P<0.05),而3组患者的胶体液输入量差异无统计学意义(P>0.05)。3组患者的术中出血量差异有统计学意义,PPV1组最多(P<0.05)。3组患者的麻黄碱和去甲肾上腺素使用率差异有统计学意义,对照组使用率最高(P<0.05),PPV1组和PPV2组差异无统计学意义(P>0.05)。3组患者的恶心呕吐发生率、胃肠恢复时间差异有统计学意义,其中PPV2组恶心呕吐发生率最低,胃肠功能恢复时间最短(均P<0.05),而3组患者的肺部感染发生率差异无统计学意义(P>0.05)。结论开腹肝脏手术中采用以PPV(维持在10%~15%)为目标导向的液体治疗,可减少术中出血量和晶体液输入量,提高血流动力学稳定性,缩短胃肠道功能恢复时间,减少术后恶心呕吐的发生。Objective To investigate the application effect of goal-directed fluid therapy using pulse pressure variation(PPV)in open liver surgery.Methods Ninety patients undergoing elective open liver surgery were randomly divided into control group,PPV1 group and PPV2 group,with 30 cases in each group.Patients in the three groups all received general anesthesia with endotracheal intubation.The control group undertook fluid management directed by controlled central venous pressure reduction technology;both the PPV1 and PPV2 groups received fluid therapy directed by PPV,wherein the PPV1 group kept PPV at a level of<10%,while the PPV2 group kept PPV at a level of 10%to 15%.Mean arterial pressure(MAP)and heart rate before and after hepatic portal occlusion were recorded in the three groups.Intraoperative crystalloid solution and colloid solution input,total infusion volume,blood loss and vasoactive drug use,as well as postoperative conditions of nausea and vomiting,pulmonary infection and gastrointestinal recovery were recorded in the three groups.Results After hepatic portal occlusion,MAP decreased and heart rate increased in the three groups as compared with those before occlusion(P<0.05),the control group exhibited the largest decrease in MAP reduction and the largest increase in heart rate elevation,followed by the PPV2 group and the PPV1 group(all P<0.05).There were statistically significant differences in crystalloid solution input and total infusion volume among the three groups,crystalloid solution input and total infusion volume of the control group,the PPV2 group and the PPV1 group increased successively(all P<0.05),furthermore,no statistically significant difference was found in colloid solution input among the three group(P>0.05).Intraoperative blood loss showed statistically significant difference among the three groups,and the largest volume was observed in the PPV1 group(P<0.05).The ephedrine/phenylephrine utilization rate showed statistically significant difference among the three groups,the highest rate was s

关 键 词：目标导向 液体管理 脉压变异率 开腹肝脏手术 液体出入量 并发症 

分 类 号：R614[医药卫生—麻醉学]