SVV目标导向液体治疗对小儿亲体肝移植术后肺部并发症发生的影响  

Effect of stroke volume variation goal-directed fluid therapy on postoperative pulmonary complications after pediatric living donor liver transplantation

作　　者：窦晓婧 王清平[2] 刘伟华[2] 孙英[2] 翁亦齐[2] 喻文立[2] Dou Xiaojing;Wang Qingping;Liu Weihua;Sun Ying;Weng Yiqi;Yu Wenli(The First Central Clinical School,Tianjin Medical University,Tianjin 300192,China;Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院麻醉科,天津300192

出　　处：《中华麻醉学杂志》2023年第6期709-713,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金面上项目(82072219);天津市卫生健康委员会科技项目(ZC20223,ZC20052);天津市医学重点学科(专科)建设项目(TJYXZDXK-045A)。

摘　　要：目的评价每搏变异度(SVV)目标导向液体治疗对小儿亲体肝移植术后肺部并发症(PPCs)发生的影响。方法选取亲体肝移植术患儿(均诊断为先天性胆道闭锁)120例,采用随机数字表法分为2组(n=60):对照组和SVV组。对照组以CVP、MAP为目标导向指导术中液体管理,SVV组术中以SVV联合CO为目标导向进行液体管理。记录术中循环情况、液体入量及血管活性药物使用情况。分别于麻醉前(T_(0))、无肝期末(T_(1))、新肝期3 h(T_(2))、术毕(T_(3))和术后24 h(T_(4))时采集中心静脉血样,测定血清克拉拉细胞分泌蛋白16(CC16)、IL-6和TNF-α浓度。于术前、术毕及术后1、3和7 d时进行肺部超声检查记录肺部超声评分。随访术后1周PPCs包括急性肺损伤、肺感染、肺不张、胸腔积液、急性呼吸窘迫综合征的发生情况。结果与对照组比较,SVV组患儿PPCs发生率、急性肺损伤和肺感染发生率降低,术毕、术后1、3和7 d时肺部超声评分降低,术中多巴酚丁胺用量增加,PRS持续时间缩短,液体入量和肾上腺素用量减少,T_(1~4)时血清CC16、TNF-α和IL-6浓度降低(P<0.05)。结论SVV目标导向液体治疗可减少小儿亲体肝移植PPCs的发生。Objective To evaluate the effect of stroke volume variation(SVV)goal-directed fluid therapy on postoperative pulmonary complications(PPCs)after pediatric living donor liver transplantation.Methods One hundred and twenty pediatric patients undergoing pediatric living-donor liver transplantation(all diagnosed with congenital biliary atresia)were divided into 2 groups(n=60 each)using the random number table method:control group and SVV group.Intraoperative fluid management was guided by central venous pressure and mean arterial pressure in control group,while by SVV combined with cardiac output in SVV group.Intraoperative circulation,fluid intake and usage of vasoactive drug were recorded.Central venous blood samples were collected to determine the concentrations of serum Clara cell 16 kDa protein,interleukin-6,and tumor necrosis factor-alpha before anesthesia(T_(0)),at the end of anhepatic phase(T_(1)),at 3 h of neohepatic phase(T_(2)),at the end of surgery(T_(3))and at 24 h after operation(T_(4)).Pulmonary ultrasonography was performed before surgery,at the end of surgery and at 1,3 and 7 days after surgery.The pediatric patients were followed up for 1 week after surgery to record the PPCs,including acute lung injury,pulmonary infection,pulmonary atelectasis,pleural effusion and acute respiratory distress syndrome.Results Compared with control group,the incidence of PPCs,acute lung injury and pulmonary infection was significantly decreased,the pulmonary ultrasound score was decreased at the end of surgery and at 1,3 and 7 days after surgery,the usage of intraoperative dobutamine was increased,the duration of postreperfusion syndrome was shortened,the fluid intake and epinephrine usage were reduced,and the serum Clara cell 16 kDa protein,tumor necrosis factor-alpha and interleukin-6 concentrations were decreased at T_(1)-T_(4)in SVV group(P<0.05).Conclusions SVV goal-directed fluid management can reduce the development of PPCs in pediatric living donor liver transplantation.

关 键 词：每搏输出量 补液疗法 儿童 肝移植 肺 手术后并发症 

分 类 号：R726.5[医药卫生—儿科]