目标导向液体治疗对妇科腹腔镜手术患者循环和术后恶心呕吐的影响  

Effects of TEE-goal-directed fluid therapy on circulation and PONV in patients undergoing gynecological laparoscopic surgery

作　　者：纪洪波[1] 李泽宇 王国林 JI Hongbo;LI Zeyu;WANG Guolin(Department of Anesthesiology,Tianjin Baodi Hospital,Tianjin 301800,CHINA)

机构地区：[1]天津市宝坻区人民医院麻醉科,301800 [2]天津医科大学总医院

出　　处：《江苏医药》2021年第10期1020-1023,共4页Jiangsu Medical Journal

摘　　要：目的探讨经食管超声心动图(TEE)目标导向液体治疗对妇科腹腔镜手术患者循环和术后恶心呕吐(PONV)发生的影响。方法择期妇科腹腔镜手术患者160例随机分为两组,每组80例。麻醉期间,R组输注复方乳酸钠30 mL/kg,GR组给予复方乳酸钠15 mL/kg+聚明胶肽15 mL/kg。以TEE监测心室充盈为目标导向指导输液速度,测量心脏指数(CI)评估液体治疗效果。记录术后24 h内的PONV发生率;观察术中CI、BP、HR和SpO_(2)的变化。结果GR组术后24 h内PONV发生率低于R组(13%vs.32%)(P<0.05)。两组术中BP、HR、SpO_(2)和CI差异无统计学意义(P>0.05)。结论全身麻醉诱导可以降低妇科腹腔镜手术患者CI,采用TEE目标导向液体治疗,特别是复合应用晶体液和胶体液能快速恢复并有效维持术中循环稳定,减少PONV的发生。Objective To investigate the effects of transesophageal echocardiography(TEE)goal-directed fluid therapy on the circulation and postoperative nausea and vomiting(PONV)in the patients undergoing gynecological laparoscopic surgery.Methods A total of 160 patients undergoing selective gynecologic laparoscopic surgery were randomly divided into two groups with 80 cases each.During operation,TEE goal-directed fluid therapy was performed with compound sodium lactate liquid 30 mL/kg in group R and combined use of compound sodium lactate liquid 15 mL/kg and polygelatin petide 15 mL/kg in group GR.The infusion speed was goal-directed by ventricular filling monitored with TEE.The efficacy of fluid therapy was evaluated with cardiac index(CI)measurement.The incidence rates of PONV during postoperative period of 24 hours were recorded.The changes of BP,HR,SpO_(2) were compared between the two groups.Results The incidence rates of PONV during the periods of 24 hours were lower in group GR than those in group R(13%vs.32%)(P<0.05).The changes of BP,HR,SpO_(2) and CI were not significantly different between the two groups(P>0.05).Conclusion The CI of patients undergoing gynecological laparoscopic surgery is decreased during induction of general anesthesia,which can be quickly restored and maintained stable by TEE goal-directed fluid therapy,especially with combined use of crystalloid fluids and colloid fluids,with reduced occurrence of PONV.

关 键 词：目标导向液体治疗 术后恶心呕吐 妇科腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]