潮气量挑战PPV与PPV在老年髋关节手术中对目标导向液体容量管理策略的影响研究  

Volume challenge pulse pressure variation(VtPPV)and effect of pulse pressure variation(PPV)on goal-directed fluid volume management strategies in elderly hip surgery

作　　者：李海丽 王艳飞 张小引 LI Haili;WANG Yanfei;ZHANG Xiaoyin(Department of Anesthesiology,Affiliated Hospital of Southeast University School of Medicine/Nanjing Tongren Hospital,Nanjing 211102,China)

机构地区：[1]东南大学医学院附属医院/南京同仁医院麻醉科,南京211102

出　　处：《新疆医科大学学报》2024年第3期388-392,共5页Journal of Xinjiang Medical University

基　　金：2019年高层次卫生人才“六个一工程”拔尖人才科研项目和全省人事人才管理课题(LGY2019078)。

摘　　要：目的 比较潮气量挑战脉压变异率(Volume challenge pulse pressure variation, VtPPV)和脉压变异率(Pulse pressure variation, PPV)两种液体目标导向管理方法对老年髋关节手术输液量以及预后的影响。方法 以2020年3月-2023年3月在东南大学医学院附属医院/南京同仁医院麻醉科全麻下行择期髋关节手术的100例患者为研究对象,采用随机数字表法分为潮气量挑战PPV(VtP组)和PPV组(P组),每组50例。VtP组:将潮气量从6 mL/kg增加到8 mL/kg并持续1 min,若ΔPPV≥3.5%,10 min内予以200 mL胶体液快速输注;并在液体预负荷结束前1 min内重复测量并干预。若连续2次显示容量欠佳,第二次输注晶体液200 mL,直至ΔPPV<3.5%。P组:潮气量为8 mL/kg时,若PPV≥11%持续1 min, 10 min内予以200 mL胶体液输注;并在液体预负荷结束前1 min内重复测量并干预。若连续2次显示容量欠佳,第二次输注晶体液200 mL,直至PPV<11%。记录患者术中低血压时间加权平均值(Time weighted average of Hypotension, TWA)、术毕血乳酸水平、输液量、出血量、尿量,术后48 h肺部、泌尿系统并发症发生率、住院时间以及术后24、48 h QoR-15满意度评分。记录患者入室、插管后、切皮时、以及术中不同时间点平均动脉压和心率的情况。结果 与P组比较,VtP组术毕总输液量、晶体用量和血乳酸水平减少,胶体用量增多,手术开始60、90 min时平均动脉压增高,术中TWA降低,术后24 h恢复满意度评分增大,差异有统计学意义(P<0.05)。结论 在老年髋关节手术中,基于潮气量挑战PPV的目标导向液体容量管理策略围术期低血压发生少,可降低术中输液量,提高患者满意度。Objective To compare the effects of 2 fluid goal-oriented management methods,volume challenge pulse pressure variation(VtPPV)and pulse pressure variation(PPV)on the infusion volume and prognosis of elderly hip surgery.Methods 100 patients who underwent elective hip surgery under general anesthesia in the hospital from September 2021 to August 2023 were selected as research subjects.The pa-tients were divided into tidal volume challenge PPV(VtP group)and PPV group(P group)using the ran-dom number table method,50 cases in each group.In VtP group,the tidal volume was increased from 6 mL/kg to 8 mL/kg for 1 min.IfΔPPV≥3.5%,200 mLcolloidalsolution was injected quickly with in 10 min.The measurement and intervention were repeatedwithin 1 min before the end of fluid preload.If the displayvolume was not good for two consecutive times,the second infusion of 200 mL crystal solution untilΔPPV<3.5%.In Pgroup,when the tidal volume was 8 mL/kg,if PPV≥11%persists for 1 minute,200 mL of colloidal solution was injected within 10 mins.The measurement and intervention were repeated with in 1 min before the end of fluid preload.If the displayvolume was not good for 2 consecutive times,the second infusion of 200 mL of crystal solution until the PPV<11%.Time weighted average of hypoten-sion(TWA),blood lactate level,transfusion volume,blood loss and urinewere recorded.Incidence of pul-monary and urinary complications 48 hafter surgery,length of hospital stayand QoR-15 satisfaction score 24 and 48 hafter surgery.The mean arterial pressure and heart rate were recorded athome,after intubation,during in-cision,and at different time points during the operation.Results Compared with P group,the the total infusion volume,crystal dosage and blood lactate level in VtP group after operation were reduced,the colloid dosage was increased,the mean arterial pressure was increasedat 60 and 90 mins at the beginning of operation,the intraopera-tive TWA was decreased,and the recovery satisfaction score at 24 hafter operation was increased,with sta

关 键 词：潮气量挑战 脉压变化 目标导向液体 时间加权平均值 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]