目标导向液体治疗在经阴道混合自然腔道内镜手术肾切除术中的应用价值  

Application value of goal-directed fluid therapy in transvaginal mixed natural orifice transluminal endoscopic surgery nephrectomy

作　　者：邹平 李国强[2] 单热爱[2] 钟茂林[2] 管俊辉 占丽芳[2] ZOU Ping;LI Guoqiang;SHAN Re'ai;ZHONG Maolin;GUAN Junhui;ZHAN Lifang(Department of Anesthesiology,Ganzhou Cancer Hospital,Ganzhou,Jiangxi,341000,China;Department of Anesthesiology,the First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi,341000,China)

机构地区：[1]赣州市肿瘤医院麻醉科,江西赣州341000 [2]赣南医学院第一附属医院麻醉科,江西赣州341000

出　　处：《当代医学》2024年第36期76-80,共5页Contemporary Medicine

基　　金：江西省卫生健康委科技计划(20204493)。

摘　　要：目的探讨目标导向液体治疗(goal-directed fluid therapy,GDFT)在经阴道混合自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)肾切除术中的应用价值。方法选取2020年1月至2021年12月赣南医学院第一附属医院行经阴道混合NOTES肾切除术的40例患者作为研究对象,按照随机数字表法分为对照组与观察组,每组20例。对照组给予常规输液治疗,观察组给予GDFT治疗。比较两组血流动力学[平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)]、围手术期不良事件及预后情况。结果T_(1)时,两组MAP均高于T_(2)、T_(3)、T_(4),HR均快于T_(2)、T_(3)、T_(4),T_(2)时,对照组MAP高于T_(3)、T_(4),两组MAP均低于T_(5),观察组HR慢于T_(4),两组HR均慢于T_(5),T_(4)时,两组MAP均高于T_(5),HR均快于T_(5),差异有统计学意义(P<0.05);T_(4)时,观察组MAP高于对照组,HR快于对照组,差异有统计学意义(P<0.05)。观察组围手术期不良事件发生率低于对照组,差异有统计学意义(P<0.05)。术后30 d,两组卡氏功能状态、生命质量量表评分均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论经阴道混合NOTES肾切除术中,GDFT通过精准的血流动力学监测与个体化液体管理,可显著提高术中循环稳定性,降低围手术期并发症发生率,并改善患者术后生命质量。Objective To explore the application value of goal-directed fluid therapy(GDFT)in transvaginal mixed natural orifice transluminal endoscopic surgery(NOTES)nephrectomy.Methods 40 patients who underwent transvaginal mixed NOTES nephrectomy in the First Affiliated Hospital of Gannan Medical University from January 2020 to December 2021 were selected as the research subjects,they were divided into the control group and the observation group according to the random number table method,with 20 cases in each group.The control group was treated with routine infusion,and the observation group was treated with GDFT.The hemodynamics(mean arterial pressure[MAP],heart rate[HR]),perioperative adverse events and prognosis were compared between the two groups.Results At T_(1),the MAP of the two groups were higher than that at T_(2),T_(3)and T_(4),and the HR were faster than that at T_(2),T_(3)and T_(4),at T_(2),the MAP in the control group was higher than that at T_(3)and T_(4),and the MAP of the two groups were lower than that at T_(5);the HR in the observation group was slower than that at T_(4),and the HR of the two groups were slower than those at T_(5),at T_(4),the MAP of the two groups were higher than that at T_(5),and the HR was faster than that at T_(5),the differences were statistically significant(P<0.05);at T_(4),the MAP in the observation group was higher than that in the control group,and the HR was faster than that in the control group,the differences were statistically significant(P<0.05).The incidence of perioperative adverse events in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).At 30 d after operation,the Karnofsky performance status and quality of life scores of the two groups were higher than those before operation,and the observation group was higher than the control group,the differences were statistically significant(P<0.05).Conclusion In transvaginal mixed NOTES nephrectomy,GDFT significantly improves intraoperative circulatory stabil

关 键 词：目标导向液体治疗 经阴道混合自然腔道内镜手术 肾切除术 血流动力学 

分 类 号：R47[医药卫生—护理学]