SmO_(2)目标导向血流动力学管理对高血压患者腹腔镜胃肠肿瘤根治术后肾功能的影响  

Effect of SmO_(2) goal-directed hemodynamic management on postoperative renal function in hypertensive patients undergoing laparoscopic radical gastrectomy for gastrointestinal tumors

作　　者：袁畅[1] 许颖 王洁 张超凡 何龙[1] 艾艳秋[1] Yuan Chang;Xu Ying;Wang Jie;Zhang Chaofan;He Long;Ai Yanqiu(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Anesthesiology and Perioperative Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,郑州450052 [2]郑州大学附属郑州中心医院麻醉与围术期医学科,郑州450007

出　　处：《中华麻醉学杂志》2022年第12期1432-1436,共5页Chinese Journal of Anesthesiology

基　　金：河南省医学科技攻关计划项目(LHGJ20190211);国家自然科学基金青年科学基金项目(82001189)。

摘　　要：目的:评价肌氧饱和度(SmO_(2))目标导向血流动力学管理对高血压患者腹腔镜胃肠肿瘤根治术后肾功能的影响。方法:择期行腹腔镜胃肠肿瘤根治术的原发性高血压患者86例,性别不限,年龄18~64岁,ASA分级Ⅱ或Ⅲ级,BMI≤30 kg/m^(2),采用随机数字表法分为2组(n=43):常规组(C组)和SmO_(2)目标导向组(S组)。C组采用调整输液速度及血管活性药物,维持MAP和HR波动幅度不超过基础值20%;S组通过评估CO、HR、SV、SVV、SVRI和MAP,采用调整输液速度及血管活性药物,维持SmO_(2)不低于70%或基线值。分别于麻醉诱导前(T_(0),基线值)、手术开始(T_(1))、气腹开始后40 min(T_(2))、气腹结束后5 min(T_(3))和手术结束(T_(4))时,记录SmO_(2)、HR、MAP、CO、CI、SVV和SVRI。分别于术前和术后24 h时测定肾小球滤过率,记录术后急性肾功能下降发生情况。记录术中低血压发生情况、液体出入量和术后气管拔管时间、住院时间、急性肾损伤发生情况、转入ICU情况、术后24 h的15项恢复质量量表评分。结果:与C组比较,S组T_(1-3)时SmO_(2)、T_(3)时CO和CI升高,T_(2-4)时SVRI降低,术中输液量和尿量升高,术后24 h肾小球滤过率和15项恢复质量量表评分升高,急性肾功能下降发生率降低(P<0.05),术中低血压发生率、出血量和术后气管拔管时间、住院时间、急性肾损伤发生率、转入ICU率差异无统计学意义(P>0.05)。结论:SmO_(2)目标导向血流动力学管理可减少高血压患者腹腔镜胃肠肿瘤根治术后急性肾功能下降的发生,提高术后恢复质量。Objective To evaluate the effect of goal-directed hemodynamic management of muscle oxygen saturation(SmO_(2))on the postoperative renal function in hypertensive patients undergoing laparoscopic radical gastrectomy for gastrointestinal tumors.Methods Eighty-six essential hypertension patients,aged 18-64 yr,with body mass index≤30 kg/m^(2),of American Society of Anesthesiologists physical statusⅡorⅢ,undergoing elective laparoscopic radical gastrectomy for gastrointestinal tumors under general anesthesia,were divided into 2 groups(n=43 each)using a random number table method:routine group(group C)and SmO_(2) goal-directed group(group S).The fluctuation of mean arterial pressure(MAP)and heart rate(HR)were maintained<20%of the preoperative baseline value by adjusting infusion speed and vasoactive drugs in group C.SmO_(2) was maintained not less than 70%or not less than the baseline value by evaluating cardiac output(CO),HR,stroke volume,stroke volume variation,systemic vascular resistance index and MAP and by adjusting infusion rate and vasoactive drugs in group S.SmO_(2),HR,MAP,CO,cardiac index(CI),stroke volume variation and systemic vascular resistance index were recorded before anesthesia induction(T_(0),baseline value),at the beginning of surgery(T_(1)),at 40 min after the start of pneumoperitoneum(T_(2)),at 5 min after the end of pneumoperitoneum(T_(3)),and at the end of surgery(T_(4)).The glomerular filtration rate was measured before surgery and at 24 h after surgery,and the occurrence of decline in postoperative acute renal function was recorded.Intraoperative hypotension,fluid input and output,postoperative tracheal extubation time,length of hospital stay,occurrence of acute kidney injury and transfer to ICU,and the Quality of Recovery-15 scale score at 24 h after operation were recorded.Results Compared with group C,SmO_(2) at T_(1-3) and CO and CI at T_(3) were significantly increased,SVRI at T_(2-4) was decreased,the intraoperative infusion volume and urine volume were increased,the glomerular filtr

关 键 词：肌 骨骼 氧 血流动力学 高血压 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]