高每搏量变异度下的目标导向液体治疗在老年患者脊柱手术中的应用  

Application of goal-directed fluid therapy at high stroke volume variation in spinal surgery among elderly patients

作　　者：谢亚琼 凌云志 高兴悦 章迪 王竹 刘婉钰 李博文 陈珂 张雍兴 Xie Yaqiong;Ling Yunzhi;Gao Xingyue;Zhang Di;Wang Zhu;Liu Wanyu;Li Bowen;Chen Ke;Zhang Yongxing(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China;Graduate School of Bengbu Medical University,Bengbu 233030,China)

机构地区：[1]蚌埠医科大学第一附属医院麻醉科,蚌埠233004 [2]蚌埠医科大学研究生院,蚌埠233030

出　　处：《中华解剖与临床杂志》2024年第7期471-478,共8页Chinese Journal of Anatomy and Clinics

基　　金：安徽高校自然科学研究项目重点项目(KJ2021A0705);蚌埠医学院研究生科研创新计划项目(Byycxz22070)。

摘　　要：目的探讨允许性高每搏量变异度(SVV)指导下的目标导向液体治疗(GDFT)在老年患者脊柱手术中的应用价值。方法前瞻性随机对照研究。纳入2022年6月—2023年5月蚌埠医科大学第一附属医院择期俯卧位脊柱外科手术老年患者62例,其中男17例、女45例,年龄60~74岁,美国麻醉协会(ASA)分级Ⅱ级42例、Ⅲ级20例。62例患者采用数字表法随机分为GDFT组和传统开放液体治疗(OFT)组,每组31例。GDFT组术中使用FloTrac-Vigileo监测系统进行监测,SVV控制在13%~18%。OFT组术中采用传统开放液体治疗。观察指标:(1)比较2组患者性别、年龄、体质量指数、文化程度、ASA分级等临床基线资料,以及麻醉时间、手术时间、麻醉苏醒时间;(2)比较2组患者不同时点[入室(T 1)、俯卧位即刻(T 2)、手术1 h(T 3)、手术2 h(T 4)、术毕即刻(T 5)]时的心率、平均动脉压(MAP)、动脉血乳酸水平;(3)比较2组患者术中去甲肾上腺素用量及输入晶体总量、胶体总量、失血量、尿量;(4)比较2组患者术前1天及术后24、72 h时简易智力状态检查量表(MMSE)评分,以及术后24、72 h谵妄发生率。(5)比较2组患者术前和术后24、72 h时血清中枢神经特异蛋白(S100_(β))、C反应蛋白(CRP)、白细胞介素(IL)-6、血肌酐水平;(6)比较2组患者术后24、48 h疼痛视觉模拟评分法(VAS)评分,住院时间,以及术后感染、谵妄等并发症发生率。结果(1)2组患者临床基线资料及麻醉时间、手术时间、麻醉苏醒时间比较,差异均无统计学意义(P值均>0.05);(2)组内比较:从T 1至T 5,GDFT组和OFT组患者的心率和MAP总体呈下降趋势、动脉血乳酸水平总体呈上升趋势,差异均有统计学意义(P值均<0.001)。组间比较:GDFT组在T 3时的心率小于OFT组,差异有统计学意义(t=2.28,P=0.026);GDFT组和OFT组在其他时间心率及T 1~T 5的MAP、动脉血乳酸水平差异均无统计学意义(P值均>0.05)。(3)GDFT组术中去甲肾上�ObjectiveThis study aimed to investigate the value of permissive high stroke volume variation(SVV)-guided goal-directed fluid therapy(GDFT)in spine surgery among elderly patients.MethodsA prospective randomized controlled design was conducted in this study.Sixty-two patients with elective prone spinal surgery in the First Affiliated Hospital of Bengbu Medical University from June 2022 to May 2023 were included,including 17 males and 45 females,aged 60-74 years.Of the patients,42 had American Society of Anesthesiologists(ASA)classificationⅡand 20 had ASA classificationⅢ.The 62 patients were randomized into the GDFT group and conventional open fluid(OFT)group,with 31 cases in each group.The GDFT group was monitored intraoperatively using the FloTrac-Vigileo monitoring system,and SVV was controlled at 13%-18%.The OFT group was managed intraoperatively with traditional open fluid.The observation indexes were as follows:(1)Baseline clinical data such as gender,age,body mass index,education level,ASA classification,anesthesia time,operation time,and anesthesia awakening time of the patients were compared between the two groups.(2)The time of room admission(T 1),the prone position at the immediate moment(T 2),the operation for 1 h(T 3),the operation for 2 h(T 4),the operation at the immediate moment of the completion of the operation(T 5)with regard to the heart rate,the mean arterial pressure(MAP),and the arterial blood lactate level were also compared between the two groups.(3)In addition,the intraoperative norepinephrine dosage,total amount of crystals,total amount of colloids,blood loss,and urine volume were compared between the two groups.(4)The MMSE scores of the two groups of patients were compared on the first day before surgery and at 24 and 72 h after surgery,as well as the occurrence of delirium in the 24th and 72th postoperative hours.(5)The serum central nervous system specific protein(S100_(β)),C-reactive protein(CRP),interleukin(IL)-6,and creatinine levels of patients in the two groups were compared

关 键 词：补液疗法 血流动力学 目标导向液体治疗 每搏量变异度 老年人 脊柱手术 

分 类 号：R687.3[医药卫生—骨科学]