不同SVV指导术中液体治疗对腹腔镜肝叶切除术中出血及术后肾功能的影响  

Effects of intraoperative fluid therapy guided by different stroke volume variations on bleeding during laparoscopic hepatolobectomy and postoperative renal function

作　　者：郭高锋[1] 王洋洋 容雄飞[1] 张伟[1] 张加强[1] Guo Gaofeng;Wang Yangyang;Rong Xiongfei;Zhang Wei;Zhang Jiaqiang(Department of Anesthesiology and Perioperative Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州450003

出　　处：《中华麻醉学杂志》2021年第5期584-588,共5页Chinese Journal of Anesthesiology

基　　金：河南省医学科技攻关计划省部共建项目(SB201901090)。

摘　　要：目的:评价不同每搏量变异度(SVV)指导术中液体治疗对腹腔镜肝叶切除术中出血及术后肾功能的影响。方法:全身麻醉下行腹腔镜肝叶切除术患者135例,性别不限,年龄25~64岁,ASA分级Ⅰ~Ⅲ级,采用随机数字表法分为低SVV组(L组,维持SVV 10%~15%)、中SVV组(M组,维持SVV 16%~20%)和高SVV组(H组,维持SVV>21%),每组45例。于术前、术后1、3和5 d时采集外周静脉血,检测血清BUN、Cr和降钙素原(PCT)浓度。记录中转开腹情况、术中出血量、输血量、尿量、手术时间、住院时间、首次肛门排气时间;于入室(T_(0))、切皮(T_(1))、开始切肝(T_(2))、肝横断面完成(T_(3))和术毕(T_(4))时记录MAP、HR和乳酸(Lac);记录术中去甲肾上腺素使用情况、低血压、心律失常及术后不良反应的发生情况。结果:与L组比较,M组术中出血量和去甲肾上腺素用量、H组术中出血量、液体总入量和尿量减少,H组呋塞米和硝酸甘油用量、M组和H组术中输红细胞量增加,M组住院时间和首次肛门排气时间缩短,术后1 d时血清PCT浓度降低,T_(3,4)时MAP升高,H组T_(2~4)时Lac升高(P<0.05);与M组比较,H组术中出血量、去甲肾上腺素用量、呋塞米和硝酸甘油用量增加,液体总入量和尿量减少,住院时间和首次肛门排气时间延长,术后1 d时血清PCT浓度升高,T_(3,4)时MAP降低,T_(2~4)时Lac升高(P<0.05)。3组患者术后不良反应及术中低血压、心律失常发生率比较差异无统计学意义(P>0.05)。结论:腹腔镜肝叶切除术中以SVV 16%~20%指导液体治疗可减少术中出血,对术后肾功能影响较小,有利于术后转归。Objective To evaluate the effects of intraoperative fluid therapy guided by different stroke volume variation(SVV)s on bleeding during laparoscopic hepatolobectomy and postoperative renal function.Methods A total of 135 American Society of Anesthesiologists physical statusⅠ-Ⅲpatients of both sexes,aged 25-64 yr,scheduled for elective laparoscopic hepatolobectomy under general anesthesia,were divided into 3 groups(n=45 each)using a random number table method:low SVV group(group L),medium SVV group(group M)and high SVV group(group H).In group L,group M and group H,SVVs were maintained at 10%-15%,16%-20%and more than 21%,respectively.Before surgery and at 1,3 and 5 days after the surgery,blood samples from the peripheral vein were taken for determination of serum blood urea nitrogen,creatinine and procalcitonin(PCT)concentrations.The occurrence of conversion to laparotomy,intraoperative volume of blood loss,volume of blood transfused,urine volume,operation duration,length of hospital stay and time to first flatus were recorded.On admission to the operating room(T_(0)),at skin incision(T_(1)),at the beginning of resection of the liver(T_(2)),after resection of the lobes of the liver(T_(3))and at the end of the surgery(T_(4)),mean arterial pressure(MAP),heart rate(HR)and lactic acid(Lac)were recorded.The consumption of intraoperative norepinephrine,hypotension,arrhythmia and postoperative adverse reactions were recorded.Results Compared with group L,the intraoperative volume of blood loss and consumption of intraoperative norepinephrine in group M and intraoperative volume of blood loss,the total amount of fluid infused and urine volume in group H were significantly decreased,consumption of furosemide and nitroglycerin in group H and the total amount of red blood cells infused in M and H groups were increased,length of hospital stay and time to first flatus in group M were shortened,concentration of serum PCT at 1 day after surgery was decreased in group M,MAP at T_(3,4) was increased in group M,and Lac at T_(2~4)

关 键 词：每搏输出量 补液疗法 肝切除术 出血 肾功能试验 

分 类 号：R657.3[医药卫生—外科学]