目标导向输液在凶险性前置胎盘剖宫产术中的应用  

Application of target-directed fluid therapy in fluid management of dangerous placenta previa cesarean section

作　　者：王小红 陈亮[1] 谭稳青 李爱媛[1] 李珍[1] WANG Xiaohong;CHEN Liang;TAN Wenqing;LI Aiyuan;LI Zhen(Department of Anesthesiology,Hunan Provincial Maternal and Child Health Care Hospital,Changsha,Hunan 410008,China)

机构地区：[1]湖南省妇幼保健院麻醉科,湖南长沙410008

出　　处：《中国医学工程》2023年第8期18-22,共5页China Medical Engineering

基　　金：湖南省卫生健康委科研课题(202104110989)。

摘　　要：目的探讨使用FloTrac/Vigileo监测每搏量变异度(SVV)、心脏指数(CI)指导的输液策略在凶险性前置胎盘剖宫产术产后出血液体管理中的应用价值。方法选取2021年1月至2023年1月在湖南省妇幼保健院行择期剖宫产的凶险性前置胎盘产妇62例。在全身麻醉下行剖宫产术,随机分组,观察组(n=31)行FloTrac/Vigileo系统监测SVV、CI参数指导液体治疗,对照组(n=31)行传统血流动力学参数中心静脉压(CVP)、平均动脉压(MAP)、心率(HR)指导输液。记录患者不同时间点的血流动力学指标、凝血指标和血乳酸,术中低血压发生次数、出血量、尿量、输血量、晶体液输注量、总液体输注量,术后并发症、术中血管活性药物使用比率、术后转入ICU比率,比较上述各指标的差异。结果与对照组比,观察组术中血流动力学指标更加稳定;与对照组比,观察组术中总输液量、悬浮红细胞输注量、血浆输注量、出血量、血管活性药物使用率均显著减少,术毕乳酸、凝血酶原时间(PT)明显减小,纤维蛋白原(Fib)明显升高。结论在凶险性前置胎盘剖宫产术产后出血患者中应用FloTrac/Vigileo监测系统指导输液,可维持血流动力学稳定,减少术中输液量,改善患者术后凝血功能,优于传统输液方法。【Objective】To explore the application value of infusion strategies guided by stroke volume variation(SVV)and cardiac index(CI)monitored by FloTrac/Vigileo in the management of postpartum bleeding fluid during dangerous placenta previa cesarean section.【Methods】A total of 62 patients with dangerous placenta previa who underwent elective cesarean section were selected and randomly divided into two groups.SVV and CI parameters were monitored by FloTrac/Vigileo system to guide liquid treatment in the observation group,while traditional hemodynamic parameters[central venous pressure(CVP),mean arterial pressure(MAP),heart rate(HR)]were used to guide transfusion in the control group.Hemodynamic indexes,coagulation indexes and blood lactic acid,intraoperative hypotension frequency,blood loss,urine volume,blood transfusion volume,crystal infusion volume,total fluid infusion volume,postoperative complications,intraoperative vasoactive drug use rate,and postoperative ICU transfer rate of patients at different time points were recorded,and the differences of the above indexes were compared.【Results】Compared with the control group,the hemodynamic indexes in the observation group were more stable.Compared with the control group,the total amount of intraoperative fluid infusion,suspended red blood cell infusion,plasma infusion,blood loss and utilization rate of vasoactive drugs were significantly reduced in the observation group,the operative lactic acid and prothrombin time(PT)were significantly decreased,and the fibrinogen(Fib)was significantly increased.【Conclusion】The application of FloTrac/Vigileo monitoring system to guide transfusion in patients with dangerous postpartum hemorrhage during caesarean section of placenta previa can maintain hemodynamic stability,reduce intraoperative transfusion volume,and improve postoperative coagulation function of patients,which is superior to traditional transfusion methods.

关 键 词：凶险性前置胎盘 剖宫产 产后出血 FLOTRAC/VIGILEO 目标导向液体治疗 

分 类 号：R719.8[医药卫生—妇产科学]