SVV目标导向液体治疗对ESRD患者甲状旁腺切除术围术期血流动力学和组织灌注的影响  

Effect of stroke volume variation-guided fluid therapy on perioperative haemodynamics and tissue perfusion in patients with end-stage renal disease undergoing parathyroidectomy

作　　者：于凯丽 布特格勒其 张梦雪 王莉芳 张霄蓓 田晓明 陈雪娇 尹毅青 Yu Kaili;Bu Tegeleqi;Zhang Mengxue;Wang Lifang;Zhang Xiaobei;Tian Xiaoming;Chen Xuejiao;Yin Yiqing(Department of Anesthesiology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin′s Clinical Research Center for Cancer,Tianjin 300000,China;Department of Anesthesiology,Beijing Hospital,Beijing 100000,China;Department of Anesthesiology,China-Japan Friendship Hospital,Beijing 100000,China;Department of Anesthesiology and Perioperative Medicine,Henan Cancer Hospital,Zhengzhou 450000,China;Department of Surgical Anesthesiology,Linyi People′s Hospital,Linyi 276000,China)

机构地区：[1]天津医科大学肿瘤医院麻醉科、国家恶性肿瘤临床医学研究中心、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心,天津300000 [2]北京医院麻醉科,北京100000 [3]北京中日友好医院麻醉科,北京100000 [4]河南省肿瘤医院麻醉与围手术医学科,郑州450000 [5]临沂市人民医院手术麻醉科,临沂276000

出　　处：《中华麻醉学杂志》2023年第12期1473-1477,共5页Chinese Journal of Anesthesiology

基　　金：天津市人才引进科研启动基金(2021-1-10);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)。

摘　　要：目的评价每搏量变异度(SVV)目标导向液体治疗对终末期肾病(ESRD)患者甲状旁腺切除术围术期血流动力学和组织灌注的影响。方法择期行甲状旁腺切除术ESRD患者121例,性别不限,年龄18~64岁,BMI 18~28 kg/m^(2),术前24 h内接受血液透析治疗,ASA分级Ⅲ级。采用随机数字表法分为2组:限制性液体治疗组(SRT组,n=61)和SVV目标导向液体治疗组(GDT组,n=60)。SRT组采用限制性液体治疗,持续输注0.9%生理盐水4 ml·kg^(-1)·h^(-1)。GDT组通过SVV指导补液,当SVV≥10%持续5 min,在5 min内输注0.9%生理盐水3 ml/kg,直至SVV<10%。2组围术期维持SBP≥90 mmHg或MAP≥65 mmHg。记录术中补液量、血管活性药物使用率及用量、术毕拔除气管导管后测定动脉血乳酸(Lac)水平、MAP、HR和CO,计算下腔静脉塌陷指数(IVC-CI)。连续记录术后12 h内MAP,计算MAP变异度(CV_(MAP))。并记录术后30 d内心脑血管事件的发生情况。结果与SRT组比较,GDT组术中补液量增多,麻黄碱和去甲肾上腺素使用率降低,麻黄碱用量减少,术后IVC-CI<50%比率和CO升高,Lac水平≥2.0 mmol/L比率和CV_(MAP)降低(P<0.05)。2组术后30 d内心脑血管事件发生率比较差异无统计学意义(P>0.05)。结论与限制性液体治疗比较,SVV目标导向液体治疗可优化ESRD患者甲状旁腺切除术围术期血流动力学及组织灌注情况。Objective To evaluate the effect of stroke volume variation(SVV)-guided fluid therapy on perioperative haemodynamics and tissue perfusion in the patients with end-stage renal disease(ESRD)undergoing parathyroidectomy.Methods One hundred and twenty-one patients of either sex,aged 18-64 yr,of American Society of Anesthesiologists Physical Status classificationⅢ,with body mass index of 18-28 kg/m^(2),with ESRD undergoing elective parathyroidectomy,who received haemodialysis treatment within 24 h before surgery,were enrolled in this study.The patients were divided into standard restrictive fluid therapy group(group SRT,n=61)and goal-directed fluid therapy group(group GDT,n=60)using a random number table method.Group SRT received restrictive fluid therapy,with a continuous infusion of 0.9%normal saline at a rate of 4 ml·kg^(-1)·h^(-1).Group GDT received goal-directed fluid therapy guided by SVV,and when the SVV≥10%lasted for 5 min,the 0.9%normal saline 3 ml/kg was infused within 5 min until SVV<10%.Systolic blood pressure(SBP)was maintained at≥90 mmHg or mean arterial pressure(MAP)at≥65 mmHg throughout the perioperative period in both groups.The intraoperative volume of fluid infused,usage rate and consumption of intraoperative vasoactive drugs were recorded,and arterial blood lactate(Lac)level,MAP,heart rate,cardiac output,and inferior vena cava collapse index(IVC-CI)after removal of endotracheal tube at the end of surgery were measured.MAP was continuously recorded within 12 h after surgery,and MAP variability(CV_(MAP))was calculated.The occurrence of cardiovascular and cerebrovascular events within 30 days after operation was also recorded.Results Compared with group SRT,the intraoperative volume of fluid infused was significantly increased,the usage rate of ephedrine and norepinephrine was decreased,the consumption of ephedrine was reduced,and the percentage of postoperative IVC-CI<50%and cardiac output were increased,the percentage of Lac≥2.0 mmol/L and CV_(MAP) were decreased(P<0.05),and no significa

关 键 词：每搏输出量 补液疗法 甲状旁腺切除术 肾功能衰竭 

分 类 号：R653[医药卫生—外科学]