目标导向液体疗法与标准液体疗法对俯卧位复杂脊柱手术患者气囊泄漏梯度的影响比较  

Effect of goal-directed fluid therapy versus standard fluid therapy on cuff leak gradient in patients with complex spine surgery in prone position

作　　者：唐宝芹 孙学梁 周钦海[2] TANG Baoqin;SUN Xueliang;ZHOU Qinhai(Department of Anesthesiology,Baoying County Hospital of Traditional Chinese Medicine in Jiangsu Province,Baoying,Jiangsu,225899;Department of Anesthesiology,Jiangsu Provincial People′s Hospital,Nanjing,Jiangsu,210029)

机构地区：[1]江苏省宝应县中医医院麻醉科,江苏宝应225899 [2]江苏省人民医院麻醉科,江苏南京210029

出　　处：《实用临床医药杂志》2022年第24期37-40,45,共5页Journal of Clinical Medicine in Practice

基　　金：2020年江苏省重点研发计划专项资金项目(BE2020771)。

摘　　要：目的比较目标导向液体疗法(GFT)与标准液体疗法(SFT)对俯卧位复杂脊柱手术患者气囊泄漏梯度(CLG)以及术后咽喉痛、声音嘶哑的影响。方法将90例行俯卧位复杂脊柱手术患者随机分为GFT组和SFT组,每组45例。GFT组实施GFT,SFT组实施SFT。记录术后48 h内因喉头水肿/喘鸣引起的呼吸困难和二次插管情况;评估患者术后24 h内咽喉痛和声音嘶哑情况;记录患者住院时间和ICU停留时间。结果GFT组患者ICU停留时间短于SFT组患者,差异有统计学意义(P<0.05)。GFT组患者拔管前气囊泄漏值(CLV_(BE))高于SFT组患者,CLG低于SFT组患者,差异有统计学意义(P<0.05)。GFT组患者咽喉痛评分、声音嘶哑评分以及声音嘶哑例数低于SFT组患者,差异有统计学意义(P<0.05)。GFT组咽喉痛例数低于SFT组,但差异无统计学意义(P=0.054)。结论与SFT相比,GFT可显著降低俯卧位复杂脊柱手术患者术后喉头水肿风险,降低术后咽喉痛及声音嘶哑发生率,缩短ICU停留时间。Objective To compare the effects of goal-directed fluid therapy(GFT)versus standard fluid therapy(SFT)on cuff leak gradient(CLG),postoperative sore throat and hoarseness in patients with complex spine surgery in prone position.Methods A total of 90 patients with complex spinal surgery in prone position were randomly divided into GFT group and SFT group,with 45 cases in each group.Patients in the GFT group received GFT,while the patients in the SFT group received SFT.The dyspnea and the second intubation caused by laryngeal edema or stridor within 48 h after operation were recorded;the patients’sore throat and hoarseness within 24 hours after operation were evaluated;the patients’hospitalization time and stay time in ICU were recorded.Results The stay time in ICU in the GFT group was significantly shorter than that in the SFT group(P<0.05).The cuff leak value before extubation(CLV_(BE))in the GFT group was significantly higher than that in the SFT group,while the CLG was significantly lower than that in the SFT group(P<0.05).The score of sore throat,score of hoarseness and the number of cases with hoarseness in the GFT group were significantly lower than those in the SFT group(P<0.05).The number of cases with sore throat in the GFT group were lower than those in the SFT group,but the difference was not statistically significant(P=0.054).Conclusion Compared with SFT,GFT can significantly reduce the risk of postoperative laryngealedema,reduce the incidence rates of postoperative sore throat and hoarseness,and shorten the ICU stay in patients with complex spine surgery in prone position.

关 键 词：目标导向液体疗法 标准液体疗法 复杂脊柱手术 气囊泄漏梯度 气囊泄漏值 

分 类 号：R826.64[医药卫生—临床医学] R614