老年高血压患者胸腔镜食管癌根治术中目标导向液体治疗的应用效果  

Effect of goal-directed liquid therapy in thoracoscopic radical resection of esophageal cancer for elderly hypertensive patients

作　　者：张明敏[1] 樊雅玲[1] 庞波[1] ZHANG Mingmin;FAN Yaling;PANG Bo(Department of Anesthesiology,Leshan City People′s Hospital in Sichuan Province,Leshan,Sichuan,614000)

机构地区：[1]四川省乐山市人民医院麻醉科,四川乐山614000

出　　处：《实用临床医药杂志》2021年第22期1-4,共4页Journal of Clinical Medicine in Practice

基　　金：四川省医学会高血压疾病(泰阁)专项科研课题(2019TG06)。

摘　　要：目的探讨老年高血压患者胸腔镜食管癌根治术中应用脉压变异率(PPV)目标导向液体治疗(GDFT)对患者术中血流动力学及术后早期并发症的影响。方法选取80例行胸腔镜食管癌根治术的老年高血压患者为研究对象,随机将患者分为2组,其中对照组37例采用限制液体治疗方案,观察组43例术中采用PPV指导下的GDFT液体管理。记录2组患者术中麻醉诱导前(T;)、气腹建立开始切皮(T;)、手术1 h(T;)、手术完结(T;)时平均动脉压(MAP)、心率(HR)、心排量(CO)、心脏指数(CI)等血流动力学指标;比较2组术中输液总量、术中出血量、尿量及去甲肾上腺素应用患者占比;观察2组术后3d动脉血氧分压[p;(O;)]、动脉血二氧化碳分压[p;(CO;)];记录2组患者术后肛门排气时间、术后住院时间及并发症发生情况。结果观察组T;、T;时点HR低于对照组,MAP、PPV、CO、CI指标高于对照组,术中总液体量、尿量少于对照组,去甲肾上腺素应用患者占比低于对照组,差异均有统计学意义(P<0.05)。观察组术后1、3 dp;(O;)高于对照组,p;(CO;)低于对照组,术后疼痛、恶心、呕吐、咳嗽、咳痰并发症发生率低于对照组,排气时间及术后住院时间短于对照组,差异均有统计学意义(P<0.05)。结论老年高血压患者胸腔镜食管癌根治术中应用PPV下GDFT能够更好地完成术中液体管理,术后肠胃道功能恢复更快,并发症更少。Objective To explore the effect of goal-directed fluid therapy(GDFT) using pulse pressure variation(PPV)in thoracoscopic radical resection of esophageal cancer for elderly patients with hypertension. Methods A total of 80 elderly patients with hypertension who underwent thoracoscopic radical resection of esophageal cancer were selected as research objects, these patients were randomly divided into two groups. A total of 37 cases in control group were treated with fluid restriction during the operation. In the observation group, 43 cases were treated with GDFT fluid management under the guidance of PPV during the operation. Intraoperative hemodynamic indexes including mean arterial pressure(MAP), heart rate(HR), cardiac displacement(CO) and cardiac index(CI) were recorded in two groups before anesthesia induction(T;), at the beginning of pneumoperitoneum establishment(T;), 1 h after surgery(T;) and at the end of surgery(T;). The total amount of intraoperative infusion, intraoperative blood loss, urine volume and the proportion of patients using norepinephrine were compared between the two groups. Arterial partial pressure of oxygen[p;(O;)]and arterial partial pressure of carbon dioxide[p;(CO;)]were observed 3 days after operation. Postoperative anal exhaust time, postoperative hospital stay and complications were recorded in two groups. Results HR at T;and T;in the observation group was lower than control group, indicators such as MAP, PPV, CO, and CI were higher than that in the control group, intraoperative total fluidvolume and urine volume were less than those in the control group, and the proportion of patientsreceivingnorepinephrine was lower than that in the controlgroup(P< 0. 05). Postoperativepa(O2)in the observation group at 1, 3 d was higher than that in the control group,pa(CO2) was lowerthan the control group, complication rates of postoperative pain,nausea, vomiting, cough, and spu-tum were lower than those in the control group, the exhaust time and postoperative hospital stay wereshorter than those

关 键 词：脉压变异率 目标导向液体治疗 食管癌根治术 高血压 麻醉管理 

分 类 号：R472.3[医药卫生—护理学] R544.1[医药卫生—临床医学]