目标导向液体治疗对腹腔镜肝切除术中血流动力学及脑氧饱和度的影响  

Effect of goal‑directed fluid therapy on hemodynamics and cerebral oxygen saturation during laparoscopic hepatectomy

作　　者：张华明 韩明明 李启健 唐朝亮 章敏[1] 谢言虎 Zhang Huaming;Han Mingming;Li Qijian;Tang Chaoliang;Zhang Min;Xie Yanhu(Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院麻醉科,合肥230001

出　　处：《国际麻醉学与复苏杂志》2022年第5期476-480,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(81801175);中国博士后科学基金(2019M662179)。

摘　　要：目的观察目标导向液体治疗(goal⁃directed fluid therapy,GDFT)对腹腔镜肝切除术中血流动力学及局部脑氧饱和度(regional cerebral oxygen saturation,rSO_(2))的影响。方法40例18~71岁择期全身麻醉下行腹腔镜肝切除术患者,按随机数字表法分为以每搏量变异度(stroke volume variation,SVV)和心指数(cardiac index,CI)为指导的治疗组(S组)、以CVP为指导的治疗组(C组),每组20例。两组患者均采用气管插管全身麻醉,行桡动脉及颈内静脉穿刺,其中S组通过桡动脉连接LiDCOrapidV2系统监测SVV和CI,C组通过压力传感器连接颈内静脉导管监测CVP。记录两组患者一般情况、手术时间、拔管时间、肝门阻断时间;记录两组患者入室(T_(0))、气腹即刻(T_(1))、切肝前10 min(T_(2))、切肝后10 min(T_(3))、气腹结束即刻(T_(4))的MAP、心率、血乳酸(lactic acid,Lac)、血糖、rSO_(2);记录两组患者术中出入量、去甲肾上腺素用量及术后恢复情况(下床时间、排气时间、住院天数、术后恶心呕吐及术后感染发生率)。结果T_(2)、T_(3)时,两组患者心率、MAP均低于T(0 P<0.05),S组心率低于C组,MAP高于C组(P<0.05)。与T_(0)比较,C组T_(2)、T_(3)时血Lac及血糖升高(P<0.05),且T_(2)、T_(3)时C组高于S组(P<0.05)。两组患者各时点rSO_(2)比较,差异无统计学意义(P>0.05)。与C组比较,S组总输液量、晶体液用量、出血量、去甲肾上腺素用量降低(P<0.05),胶体液用量增加(P<0.05)。两组患者尿量差异无统计学意义(P>0.05)。与C组比较,S组下床时间、排气时间、住院天数缩短(P<0.05),术后恶心呕吐、术后感染发生率降低(P<0.05)。其余指标差异无统计学意义(P>0.05)结论腹腔镜肝切除术中以SVV和CI为指导的GDFT安全、有效,血流动力学更加平稳,促进胃肠功能恢复;缩短术后住院时间,患者短期转归较好,并能维持脑氧供需平衡。Objective To observe the effect of goal⁃directed fluid therapy(GDFT)on hemodynamics and regional cerebral ox⁃ygen saturation(rSO_(2))during laparoscopic hepatectomy.Methods A total of 40 patients,aged 18 to 71 years,who were scheduled for laparoscopic hepatectomy under general anesthesia were selected.According to the random number table method,they were divided into two groups(n=20):a stroke volume variation(SVV)and cardiac index(CI)directed treatment group(group S)and a central venous pressure(CVP)directed group(group C).Both patients were under general anesthesia with endotracheal intubation and underwent radi⁃al artery and internal jugular vein punctures.In group S,SVV and CI were monitored through the LiDCOrapidV2 system connected to the radial artery,while in group C,CVP was monitored through a pressure transducer connected to an internal jugular vein catheter.Their general information,operation time,exbubation time,and obstructive time of the portal vein were recorded.Both groups were com⁃pared for mean arterial pressure(MAP),heart rate,the concentration of blood lactic acid(Lac),blood glucose,and rSO_(2) when entry into the operating room(T_(0)),immediately after pneumoperitoneum(T_(1)),10 min before hepatectomy(T_(2)),10 min after pneumoperitoneum(T_(3)),and at the end of pneumoperitoneum(T_(4)).Furthermore,their volumes of intraoperative fluid inflow and outflow,norepinephrine dosage and postoperative recovery(time to out⁃of⁃bed activity,time to anal exhaust,length of hospitalization stay,and the incidences of nausea,vomiting,and postoperative infection)were also recorded.Results At T_(2) and T_(3),the heart rate and MAP of both groups de⁃creased compared with those at T_(0).Group S showed lower heart rate but higher MAP than group C(P<0.05).Compared with those at T_(0),the levels of Lac and blood glucose increased at T_(2) and T_(3) in group C,and the levels of Lac and blood glucose in group C were higher than those in group S(P<0.05).No statistically significant differences were observed

关 键 词：腹腔镜治疗术 肝 目标导向液体治疗 每搏量变异度 心指数 血流动力学 脑氧饱和度 

分 类 号：R614[医药卫生—麻醉学]