每搏量变异度指导目标导向输液在老年腰椎手术中的应用研究  

Study on the application of target oriented infusion with stroke volume variation guidance in elderly lumbar surgery

作　　者：胡吉 查本俊 黄凤英 张海华 HU Ji;ZHA Benjun;HUANG Fengying;ZHANG Haihua(Department of Anesthesiology,910th Hospital of PLA,Quanzhou 362000,China)

机构地区：[1]联勤保障部队第九一〇医院麻醉科,福建泉州362000

出　　处：《临床外科杂志》2025年第2期196-199,共4页Journal of Clinical Surgery

摘　　要：目的 评价每搏量变异度(SVV)指导目标导向输液在老年腰椎手术中的应用效果。方法 2023年1月~12月择期全身麻醉俯卧位腰椎手术老年病人80例,采用随机数字表法分为两组,SVV指导目标导向输液组(SVV组)和常规输液组(常规组),每组各40例。记录两组术中输液量、出血量、尿量和血管活性药物的使用情况。记录入室时(T_(1))、切皮前(T_(2))、俯卧位后1小时(T_3)和术毕(T_(4))时的MAP、HR、血乳酸浓度(Lac)、碱剩余值(BE)以及PaO_(2),术后4小时、8小时、12小时和24小时进行肺部超声检查,计算B线评分及术后24小时内心功能不全、恶心呕吐、谵妄发生和住院时间。结果 与常规组比较,SVV组术中输液量[(1123±532)ml]、血管活性药物使用率(15.0%)、术后各时点B线评分[(1.55±1.32)分,(1.22±0.94)分,(1.01±0.93)分,(1.07±0.90)分]均减少,差异有统计学意义(P<0.05);HR在T_(2)~T_(4)时[(67±8,71±11,73±12)次/分]、PaO_(2)在T_3、T_(4)时[(438±41,423±44)mmHg]均升高,Lac和BE值在T_(2)~T_(4)时[(0.3±0.5),(1.4±0.5),(1.4±0.3)mmol/L;(0.3±0.6,0.3±1.0,0.3±1.1)]则降低,差异有统计学意义(P<0.05);术后24小时内心功能不全、恶心呕吐、谵妄和住院时间两组间比较差异均无统计学意义(P>0.05)。结论 老年腰椎手术采用SVV指导目标导向输液有利于循环稳定和组织灌注,减少肺水的产生。Objective To evaluate the effect of target oriented infusion guided by stroke volume variation(SVV)in elderly lumbar surgery.Method From January to December 2023,80 elderly patients undergoing elective general anesthesia for prone lumbar surgery were divided into two groups by random number table method:SVV guidance target-oriented infusion group(SVV group)and conventional infusion group(conventional group),with 40 cases in each group.The amount of infusion,blood loss,urine volume and use of vasoactive drugs in the two groups were recorded.MAP,HR,blood lactate concentration(Lac),base residual value(BE),and PaO 2 were recorded at the time of entry(T_(1)),before cuticle(T_(2)),1 hour after prone position(T_(3)),and after surgery(T_(4)).Pulmonary ultrasound examinations were performed at 4,8,12 and 24 hours after surgery,and B-line scores were calculated,as well as the incidence of cardiac insufficiency,nausea,vomiting,delirium and hospital stay at 24 hours after surgery.Result Compared with normal group,in group SVV,intraoperative infusion volume[(1123+532)ml],vascular active drug utilization rate(15.0%),postoperative each point B line score[(1.55±1.32),(1.22±0.94),(1.01±0.93),(1.07±0.90)]were reduced(P<0.05).HR at T_(2)~T_(4)[(67±8,71±11,73±12)times/min]、PaO 2 at T_(3),T_(4)[(438±41,423±44)mmHg]were increased,Lac and BE at T_(2)~T_(4) were(0.3±0.5,1.4±0.5,1.4±0.3)mmol/L.(0.3±0.6,0.3±1.0,0.3±1.1)was decreased(P<0.05).There were no significant differences between the two groups in cardiac dysfunction,nausea,vomiting,delirium and hospital stay after a 24-hour postoperative period(P>0.05).Conclusion SVV guided target oriented infusion in elderly lumbar surgery is beneficial to circulation stability and tissue perfusion,and reduces the production of lung water.

关 键 词：目标导向输液 肺部超声 腰椎手术 老年病人 

分 类 号：R47[医药卫生—护理学]