以每搏量变异度<17%为目标导向的液体治疗在老年病人腹腔镜胃癌根治术中的可行性及有效性  

Feasibility and effectiveness of SVV<17% guided goal directed fluid therapy in laparoscopic-assisted radical gastrectomy for elderly patients

作　　者：张萌 孟香弟 王立伟[1] 赵凯 陈秀侠 ZHANG Meng;MENG Xiangdi;WANG Liwei;ZHAO Kai;CHEN Xiuxia(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China;Jiangsu Provincial Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Anesthesia,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州市中心医院麻醉科,江苏徐州221009 [2]徐州医科大学江苏省麻醉学重点实验室,江苏徐州221004 [3]徐州医科大学附属医院麻醉科,江苏徐州221002

出　　处：《安徽医药》2023年第12期2389-2393,共5页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金项目(82071903)。

摘　　要：目的探究气腹合并头高脚低位15~30°条件下以每搏量变异度(SVV)<17%为指导的目标导向液体治疗(GDFT)在老年病人中的可行性及有效性。方法选取2020年1月至2021年6月于徐州医科大学附属医院择期行腹腔镜下胃癌根治术的老年病人60例,采用随机数字表法分为目标组(n=30)和常规组(n=30)。常规组进行常规补液方案;目标组进行GDFT方案。记录气管插管后5 min(T1)、气腹及体位变动后30 min(T2)、气腹及体位变动后1.5 h(T3)、取出标本后5 min(T4)和手术结束即刻(T5)的血流动力学及组织灌注指标。结果目标组液体总入量(2142.3±156.3)mL明显低于常规组(2562.7±236.5)mL(P<0.05)。两组组间比较心指数、心输出量、SVV和每搏量均差异无统计学意义(P>0.05)。组内比较目标组和常规组在T2时点的心率均高于其余各时点(P<0.05);组间平均动脉压(MAP)的比较差异有统计学意义(P<0.05)。组内各时点中心静脉血氧饱和度(ScvO_(2))的比较在目标组中时点T2(82.8±6.1)%、T3(84.6±4.8)%、T4(83.2±5.8)%和T5(82.4±7.2)%均高于T1(76.9±5.8)%(P<0.05),常规组中各时点差异无统计学意义(P>0.05);组间乳酸(aLac)、术后排气时间比较均差异有统计学意义(P<0.05);中心静脉-动脉血二氧化碳分压差(Pcv-aCO_(2))组间组内均差异无统计学意义(P>0.05);两组间氧供指数、术后住院时间比较均差异无统计学意义(P>0.05)。结论基于本研究条件下的SVV<17%为指导的术中GDFT,可以使术中血流动力学更趋平稳,保证微循环灌注,降低术中动脉血乳酸,加快术后胃肠道功能的恢复。Objective To assess the feasibility and effectiveness of goal directed fluid therapy(GDFT)with a target of stroke volume variation(SVV)<17%under the condition of pneumoperitoneum combined with reverse Trendelenburg position at 15~30°in elderly patients.Methods Sixty elderly patients,who underwent elective laparoscopic radical gastrectomy at the Affiliated Hospital of Xuzhou Medical University from January 2020 to June 2021,were selected and randomly assigned into the target group(n=30)and the conventional group(n=30)using random number sampling method.Patients in conventional group received routine fluid replacement,while patients in target group were treated with GDFT.The indexes of hemodynamics and tissue perfusion were collected and recorded at 5 min after intubation(T1),30 min after pneumoperitoneum and postural changes(T2),1.5 h(T3)after pneumoperitoneum and postural changes,5 min(T4)after specimen removal,and the time immediately after surgery(T5).Results Compared with conventional group,target group received less fluid[(2142.3±156.3)mL vs.(2562.7±236.5)mL,P<0.05].There were no significant differences in cardiac index(CI),cardiac output(CO),SVV and stroke volume(SV)between the two groups(P>0.05).The heart rates(HR)of the target group and conventional group at T2 were higher than other time points(P<0.05).There was significant difference in the mean arterial pressure(MAP)between the two groups(P<0.05).Central venous oxygen saturation(ScvO_(2))was higher at the T2(82.8±6.1)%,T3(84.6±4.8)%,T4(83.2±5.8)% and T5(82.4±7.2)% than at T1(76.9±5.8)%in the target group(P<0.05).And in conventional group there was no statistically significant difference(P>0.05).There was significant difference in the contents of lactic acid(aLac)between the two groups(P<0.05).There was no significant difference in the central vene-arterial partial pressure of carbon dioxide(PcvaCO_(2))between the two groups(P>0.05).There was no significant difference in the oxygen supply index between the two groups(P>0.05).The time of the posto

关 键 词：补液疗法 每搏输出量 血气监测 经皮 乳酸 气腹 人工 头高脚低位 老年人 目标导向液体治疗 

分 类 号：R735.2[医药卫生—肿瘤] R614[医药卫生—临床医学]