目标导向液体治疗对老年患者腹腔镜膀胱根治性全切并肠代膀胱术中组织灌注的影响

陈惠群; 田丽平; 张鸿飞; 许平; 雷洪伊; 徐世元

文章摘要

目标导向液体治疗对老年患者腹腔镜膀胱根治性全切并肠代膀胱术中组织灌注的影响

Effect of goal directed fluid therapy on the tissue perfusion of elderly patients undergoing laparoscopic radical cystectomy

DOI：

中文关键词: 目标导向液体治疗 SVV 膀胱根治性全切术血流动力学组织灌注

英文关键词: Goal-directed fluid therapy Stroke volume variation Laparoscopic radical cystectomy Haemodynamics Tissue perfusion

基金项目:广东省科技计划项目（2014A020212202）

作者	单位
陈惠群	510280,广州市,南方医科大学珠江医院麻醉科
田丽平	广东省深圳市第二人民医院麻醉科
张鸿飞	510280,广州市,南方医科大学珠江医院麻醉科
许平	510280,广州市,南方医科大学珠江医院麻醉科
雷洪伊	510280,广州市,南方医科大学珠江医院麻醉科
徐世元	510280,广州市,南方医科大学珠江医院麻醉科

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中文摘要:

目的探讨目标导向液体治疗(goal-directed fluid therapy,GDFT)对老年患者腹腔镜膀胱根治性全切并肠代膀胱术中组织灌注的影响。方法择期行腹腔镜膀胱根治性全切并肠代膀胱术患者30例,年龄60～82岁，ASA Ⅰ或Ⅱ级,随机分为常规输液组(C组,n=15)和目标导向液体治疗组(G组,n=15)。C组术中行常规液体治疗管理,G组行GDFT,管理目标是在连续心排血量（pulse-induced contour cardiac output,PiCCO）系统监测下控制每搏变异度(SVV)≤13%、心脏指数(CI)≥2.5 L·min^-1·m^-2、ScvO₂≥73%。观测和记录麻醉诱导前(T1)、气管插管后5 min(T2)、气腹和改变体位后5 min(T3)、气腹后1 h(T4)、气腹结束开腹后5 min(T5)、开腹后1 h(T6)和手术结束即刻(T7)的血流动力学及组织灌注指标。结果 G组液体总入量明显低于C组(P＜0.05);两组MAP、SVV组间组内差异无统计学意义; T4、T6和T7时G组CI明显高于C组,T5、T6时G组HR明显快于C组(P＜0.05)。T3、T4时两组中心静脉血氧饱和度(ScvO₂)明显高于T1时(P＜0.05); T4、T5时G组乳酸(aLac)含量明显低于C组(P＜0.05);两组中心静脉-动脉血二氧化碳分压差(Pcv-aCO₂)、氧供指数(DO₂I)和氧摄取率(O₂ERe)组间组内差异均无统计学意义。结论以SVV、CI、ScvO₂为导向的GDFT可维持有效循环血容量及血压以保证全身灌注,降低aLac,改善微循环,对氧供需平衡、术后并发症及转归无明显影响。

英文摘要:

Objective To evaluate the effects of goal directed fluid therapy on the tissue perfusion of elderly patients undergoing Laparoscopic Radical Cystectomy. Methods Thirty patients aged 60-82 years with ASA physical status Ⅰ or Ⅱ who were presenting for elective laparoscopic radical cystectomy were randomly divided into routine fluid replacement group (group C, n=15) and GDFT group (group G, n=15). Patients in group C received routine fluid replacement. Patients in group G were treated under goal-directed fluid infusion strategy with a target of SVV≤13%,CI≥2.5 L·min^-1·m^-2 and ScvO₂≥73% under the monitoring of PiCCO. The indexes of hemodynamics and tissue perfusion were collected and recorded at 7 time points: before induction of anesthesia (T1), 5 minutes after intubation (T2), 5 minutes after pneumoperitoneum and change positions (T3), 1 hour after pneumoperitoneum (T4), 5 minutes after the abdomen was opened (T5), 1 hour after the abdomen was opened (T6) and the end of surgery (T7). Results Compared with group C, group G received less fluid. MAP and SVV between two groups were no statistical significance. The CI in group G in time point T4, T6 and T7 was significantly higher than that in group C (P＜0.05). The HR in group G in time point T5 and T6 was significantly higher than that in group C (P＜0.05). The aLac in group G in time point T4 and T5 was significantly lower than that in group C (P＜0.05). Pcv-aCO₂, DO₂I and O₂ERe between the two groups were not statistically different. Postoperative rehabilitation indexes between the two groups were not statistically significant. Conclusion The GDFT guided under SVV, CI and ScvO₂ can keep the effective circulatory volume and pressure to ensure the whole body perfusion, reduce aLac and improve microcirculation without affecting the balance of oxygen supply and demand and the postoperative complication.

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