目标导向性容量管理在动脉瘤性蛛网膜下腔出血患者围手术期的应用价值研究  

Study on the application value of goal-directed volume management in the perioperative peri-od of patients with aneurysmal subarachnoid hemorrhage

作　　者：龚雪 许治华 GONG Xue;XU Zhi-hua(Mianyang Hospital Affiliated to Medical College of University of Electronic Science and Technology of China/Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院,四川绵阳621000

出　　处：《实用医院临床杂志》2025年第2期149-154,共6页Practical Journal of Clinical Medicine

基　　金：四川省卫健委科研课题(编号:21PJ178)。

摘　　要：目的探讨目标导向性容量管理结合经颅彩色多普勒超声技术(TCCD)在动脉瘤性蛛网膜下腔出血(aSAH)患者围手术期的应用价值。方法选取我院收治的106例aSAH患者,采用区组随机分组法分为研究组及对照组各53例。分别接受目标导向疗法方案和常规液体治疗方案。监测两组患者手术开始时(T0)、手术结束时(T1)、术后24 h(T2)、术后3 d(T3)、术后5 d(T4)、术后7 d(T5)平均动脉压、中心静脉压、乳酸、中心静脉血氧饱和度等指标。记录两组患者机械通气时间、ICU停留时间、住院时间、急性肺水肿发生率、急性肾损伤发生率、肺部感染发生率。对比两组患者脑血管痉挛、迟发性脑缺血发生情况及30天的病死率。两组均进行TCCD检查,通过颞窗探测患侧大脑中动脉平均血流速度、Lindegaard指数、血管搏动指数。结果研究组患者在T1~T5时乳酸、中心静脉压、尿素氮均低于对照组,中心静脉血氧饱和度高于对照组(P<0.05);研究组患者在T1~T5时心脏指数(CI)、总舒张末期指数(GEDI)较T0明显增高(P<0.05);研究组累计液体正平衡量较对照组明显降低(P<0.05);研究组在T3~T5时Lindegaard指数、血管搏动指数低于对照组(P<0.05);急性肺水肿、急性肾损伤、脑血管痉挛等并发症发生率、30天病死率低于对照组(P<0.05)。结论目标导向性容量管理结合TCCD能优化患者容量,减少并发症发生率及降低病死率。Objective To investigate the application value of goal-directed volume management combined with transcranial color Doppler sonography(TCCD)in the perioperative period of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods One hundred and six patients with aSAH admitted to our hospital were selected.The patients were divided into a study group and a control group by using block randomization method,53 in each group.The study group received the goal-directed therapy regimen.The control group received the conventional fluid regimen.Mean arterial pressure,central venous pressure,lactic acid and central venous oxygen saturation were monitored.The duration of mechanical ventilation,ICU stay,hospital stay,incidence of acute pulmonary edema,acute kidney injury and pulmonary infection were recorded.Incidence of cerebral vasospasm,delayed cerebral ischemia and mortality rate in 30 days were compared between the two groups.TCCD was performed in both groups,and the mean blood flow velocity,Lindegaard index and pulsatility index of the affected middle cerebral artery were detected through the temporal window.Results Lactic acid,central venous pressure and urea nitrogen in the study group were lower than those in the control group at T1~T5,while central venous oxygen saturation was higher than that in the control group(P<0.05).CI and GEDI at T0 in the study group significantly higher than those at T1~T5,and the difference was statistically significant.Compared with the control group,the cumulative positive fluid balance in the study group was significantly lower(P<0.05);the Lindegaard index and pulsatility index in the study group were lower than those in the control group at T3~T5(P<0.05).The incidence of complications such as acute pulmonary edema,acute kidney injury,cerebral vasospasm and 30-day mortality rate in the study group were lower than those in the control group(P<0.05).Conclusion Goal-directed volume management combined with TCCD can optimize patient volume,reduce the incidence of complications and redu

关 键 词：目标导向性容量管理 经颅彩色多普勒超声技术 动脉瘤性蛛网膜下腔出血 围手术期 应用价值 

分 类 号：R619[医药卫生—外科学]