PiCCO指导下液体治疗对机器人辅助胃肠手术老年患者术中组织灌注及术后恢复质量的影响  

Effects of PiCCO-guided fluid therapy on intraoperative tissue perfusion and postoperative recovery in elderly patients undergoing robot-assisted gastrointestinal surgery

作　　者：王蔚 李佳静[1] 郭涛[1] 朱娟[1] 田伟千[1] 杨海基[1] 黄礼兵[1] WANG Wei;LI Jiajing;GUO Tao;ZHU Juan;TIAN Weiqian;YANG Haiji;HUANG Libing(Department of Anesthesiology,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院麻醉科,江苏南京210029

出　　处：《机器人外科学杂志（中英文）》2024年第4期597-602,共6页Chinese Journal of Robotic Surgery

基　　金：江苏省中医院院级课题(Y21011);江苏省中医药科技发展计划项目(WS2022018)。

摘　　要：目的:比较PiCCO指导下目标导向液体治疗与常规液体治疗法对机器人辅助下胃肠手术老年患者术中组织灌注和术后恢复情况的效果。方法:选取2022年9月—2023年6月在江苏省中医院行机器人辅助下胃肠肿瘤切除手术的43例老年患者,采用随机数字表法将其分为观察组和对照组。观察组采用PiCCO指导下液体疗法,对照组根据传统经验补液。两组均根据术中输液目标调节输液速度,必要时采用血管活性药物维持血流动力学稳定。观察两组患者术中血流动力学和组织灌注指标;记录术后排气、排便时间、进食流质时间、恶心呕吐发生率、住院时间、术后QoR-15评分。结果:与对照组相比,观察组术中输液量降低,气腹后1 h(T2)HR降低、MAP升高,气腹结束开腹后5 min(T3)ELWI降低、aLac降低(P<0.05),但两组在术后并发症、术后排气排便、术后进食情况、住院时间、QoR-15方面差异无统计学意义(P>0.05)。结论:PiCCO指导下目标导向液体治疗可在术中有效维持血流动力学平稳,减少术中肺水,有利于机体的组织灌注。Objective:To compare the effects of PiCCO-guided fluid therapy and conventional fluid therapy on intraoperative tissue perfusion and postoperative recovery of elderly patients undergoing robot-assisted gastrointestinal surgery.Methods:43 elderly patients who underwent robot-assisted gastrointestinal tumor resection under general anesthesia in Jiangsu Province Hospital of Chinese Medicine were selected and divided into two groups using random number table method.The observation group was received PiCCO-guided fluid therapy with the targeted intraoperative infusion.The control group was guided by routine strategy to maintain intraoperative infusion.The infusion rate was adjusted according to the intraoperative infusion target,and vasoactive drugs were used to maintain hemodynamic stability if necessary.The tissue perfusion indicators at different time points during surgery in the two groups of patients were compared.The time to first flatus and defecation after surgery,time to starting liquid diet,incidence of PONV,length of hospital stay,and postoperative QoR-15 score of the two groups of patients were recorded.Results:Compared with the control group,the intraoperative infusion volume in the observation group decreased,HR decreased and MAP increased 1 hour after pneumoperitoneum(T2),ELWI and aLac decreased 5 minutes after ending pneumoperitoneum to start open surgery(T3)(P<0.05).However,there was no statistically significant difference(P>0.05)between the two groups in terms of postoperative complications,postoperative flatus and defecation,postoperative diet,length of hospital stay,and QoR-15 scores.Conclusion:PiCCO-guided fluid therapy can effectively maintain hemodynamic stability during surgery,reduce intraoperative lung fluid,and facilitate tissue perfusion.

关 键 词：机器人辅助手术 胃肠肿瘤 脉搏指示连续心输出量 组织灌注 

分 类 号：R656.6[医药卫生—外科学]