脉搏压变异度指导的液体管理对腹腔镜肝切除术患者早期预后的影响  

Effects of pulse pressure variation-guided fluid therapy on early prognosis in patients undergoing laparoscopic liver resection

作　　者：季晶晶 陈鲁宁 田亚丽 马倩[1] 石雪朵 余德才[1] 朱新华[1] 仇毓东[1] 李冰冰[1] JI Jingjing;CHEN Luning;TIAN Yali;MA Qian;SHI Xueduo;YU Decai;ZHU Xinhua;QIU Yudong;LI Bingbing(Department of Anesthesia,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《临床麻醉学杂志》2022年第2期119-123,共5页Journal of Clinical Anesthesiology

基　　金：南京市青年卫生人才项目(QRX17013);南京市卫生科技发展专项资金项目(YKK17084)。

摘　　要：目的探讨脉搏压变异度(PPV)指导的液体管理策略对腹腔镜肝切除术(LLR)患者早期预后的影响。方法选择2018年10月至2019年8月择期行LLR的患者62例,男32例,女30例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:PPV导向液体治疗组(PPV组,n=32)和低中心静脉压组(LCVP组,n=30)。PPV组于肝实质离断阶段维持PPV 13%~20%。LCVP组于肝实质离断阶段维持CVP 2~5 cmH_(2)O。记录术中各类液体入量、出血量、输血量、尿量、术前、肝脏横断面完成时和术毕血乳酸浓度、手术时间、呋塞米用量、血管活性药使用例数及术中低血压发生例数。记录术前1 d及术后1、3 d Hb、Plt、ALT、AST、Alb、TBil、Cr、BUN、CRP、MDA浓度。记录术后首次肛门排气时间、首次排便时间、首次进食时间、首次下床活动时间、术后住院时间、术后并发症发生情况等。结果PPV组术中出血量明显少于LCVP组[(254.1±201.1)ml vs(405.0±312.8)ml,P<0.05],输血发生率明显低于LCVP组(6%vs 27%,P<0.05)。两组术前1 d及术后1、3 d Hb、Plt、ALT、AST、Alb、TBil、Cr、BUN、CRP、MDA浓度、术后首次肛门排气时间、首次排便时间、首次进食时间、首次下床活动时间、术后住院时间、术后并发症发生率差异均无统计学意义。结论以PPV作为LLR术中液体管理目标不仅具有成本低、使用方便等优势,并且安全可行,可以作为控制术中出血量的管理方法,且不影响患者早期预后。Objective To investigate the effect of pulse pressure variation(PPV)-guided fluid therapy on early prognosis in patients undergoing laparoscopic liver resection(LLR).Methods Sixty-two patients scheduled for elective LLR from October 2018 to August 2019,32 males and 30 females,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅡorⅢ,were enrolled and randomly divided into 2 groups using random number table method:PPV-guided fluid therapy group(group PPV,n=32)and low central venous pressure(LCVP)group(group LCVP,n=30).Fluid management strategy for group PPV was to guarantee PPV at the level of 13%-20%during the hepatic transection stage.Fluid management strategy for group LCVP was maintained at the level of 2-5 cmH_(2)O during the hepatic transection stage.All kinds of fluid intake,the intraoperative blood loss,blood transfusion,urine volume,lactic acid concentration,the duration of operation,the use of furosemidum,the use of vasoactive drugs,and the occurrence of intraoperative hypotension were recorded.The results of laboratory examination including Hb,Plt,ALT,AST,Alb,TBil,Cr,BUN,CRP and MDA contents were recorded 1 day before surgery,1 day and 3 days after surgery.The first time to flatus,the first time to defecation,the first time to oral after surgery,the time to ambulation,the length of hospital stay after surgery,and the occurrence of complications were also recorded.Results The total intraoperative blood loss of patients in group PPV was significantly less than patients in group LCVP[(254.1±201.1)ml vs(405.0±312.8)ml,P<0.05].The requirement for intraoperative transfusion was decreased in group PPV(6%vs 27%,P<0.05).There were no significant differences in Hb,PLT,ALT,AST,Alb,TBil,Cr,BUN,CRP and MDA contents 1 day before surgery,1 day and 3 days after surgery,the first time to flatus,the first time to defecation,the first time to oral after surgery,the time to ambulation,the length of hospital stay after surgery,and the occurrence of complications between the two groups.Conclusion Taking PPV as the go

关 键 词：脉搏压变异度 腹腔镜 肝切除术 目标导向液体治疗 早期预后 

分 类 号：R614[医药卫生—麻醉学]