脉搏灌注变异指数在腹腔镜胃肠手术患者围术期液体管理中的应用价值  

Application value of pleth variability index in the peri-operative liquid control of patients undergoing laparoscopic gastrointestinal surgery

作　　者：孙宜云 凌云志[1] 杨栋栋 李芷依 黄静文 董成成 Sun Yiyun;Ling Yunzhi;Yang Dongdong;Li Zhiyi;Huang Jingwen;Dong Chengcheng(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院麻醉科,安徽省蚌埠市233004

出　　处：《中华解剖与临床杂志》2021年第3期339-345,共7页Chinese Journal of Anatomy and Clinics

基　　金：安徽省高等学校自然科学重点研究项目(KJ2019A0330);蚌埠医学院研究生科研创新计划(Byycx1972)。

摘　　要：目的探讨脉搏灌注变异指数(PVI)在腹腔镜胃肠手术患者围术期液体管理中的应用价值。方法前瞻性研究。纳入2019年9月—2020年9月蚌埠医学院第一附属医院择期行腹腔镜胃肠手术的60例患者的临床资料,男39例、女21例,年龄60~70岁,美国麻醉医师协会(ASA)Ⅱ~Ⅲ级。采用随机数字表法分为两组:观察组30例,在PVI指导下补液;对照组30例,在中心静脉压、平均动脉压指导下补液。通过Masimo Radical-7和SedLine连续监测患者PVI、灌注指数(PI)、患者状态指数(PSI),术中PSI保持25~50。观察指标:(1)比较两组患者的基线资料;(2)围术期观察指标,包括术中晶体输入量、胶体输入量、输液总量、尿量,以及拔管时间、麻醉后监测治疗室(PACU)时间、警觉/镇静(OAA/S)评分、排气时间、住院时间;(3)血流动力学及容量指标,包括患者入室6 min(T0)、插管后6 min(T1)、切皮时(T2)、胃肠吻合后(T3)、拔管后6 min(T4)的心率、平均动脉压、PVI、PI、中心静脉压;(4)炎症细胞因子及动脉血乳酸指标,包括患者术前、术后第1天和第3天血浆中C反应蛋白、内毒素、降钙素原及乳酸。结果(1)两组患者基线资料比较差异均无统计学意义(P值均>0.05)。(2)两组患者拔管时间、PACU时间、OAA/S评分、住院时间差异均无统计学意义(P值均>0.05),对照组术中晶体输液量、术中输液总量、术中尿量、排气时间均高于观察组,术中胶体输液量低于观察组,差异均有统计学意义(P值均<0.05)。(3)两组间不同时间点心率、平均动脉压、PVI比较,差异均无统计学意义(P值均>0.05);对照组的中心静脉压和PVI均高于观察组,前者在T2、T4时组间比较差异有统计学意义,后者在T1、T4时组间比较差异有统计学意义(P值均<0.05)。组内不同时间点比较:两组患者的PI、对照组心率、观察组平均动脉压,差异均无统计学意义(P值均>0.05);与T0时比较,观察组心率T1~T3逐�Objective This study aimed to evaluate the application value of pleth variability index(PVI)in the peri-operative liquid control of patients undergoing laparoscopic gastrointestinal surgery.Methods This prospective study was conducted from September 2019 to September 2020.Sixty patients(39 males and 21 females,aged 60-70 years old,GradeⅡ-Ⅲof American Society of Anesthesiologists)were enrolled in the First Affiliated Hospital of Bengbu Medical College for laparoscopic gastrointestinal surgery.Random-number table method was used to divide the patients into two groups.The observation group(30 cases)received fluid rehydration under the guidance of PVI,while the control group(30 cases)received fluid supplementation under the guidance of central venous pressure and mean arterial pressure.Patient PVI,perfusion index(PI),and patient status index(PSI)were continuously monitored using Masimo Radical-7 and SedLine,and PSI was maintained between 25 and 50 intra-operatively.The outcome measures were as follows:(1)The baseline data of the two groups were compared.(2)Peri-operative observation indicators,including intraoperative crystal input,colloidal input,total infusion volume,urine volume,extubation time,post-anesthesia care unit(PACU)time,observer's assessment of alertness/sedation(OAA/S)score,exhaust time,and length of hospital stay were observed;(3)Hemodynamics and volume indexes,including heart rate,mean arterial pressure,PVI,PI,and central venous pressure of patients were observed at 6 min after admission(T0),6 min after intubation(T1),skin incision(T2),gastrointestinal anastomosis(T3),and 6 min after extubation(T4).(4)Inflammatory cytokines and arterial blood lactic acid indices,including C-reactive protein,endotoxin,procalcitonin,and lactic acid in plasma were observed before and at 1 and 3 days after surgery.Results(1)No significant difference was observed in the baseline data between the two groups(all P values>0.05).(2)No statistically significant differences were observed in extubation time,PACU time,OAA/S sc

关 键 词：胃肠外科手术 目标导向液体治疗 脉搏灌注变异指数 腹腔镜胃肠手术 炎症细胞因子 

分 类 号：R614[医药卫生—麻醉学]