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| 目标导向液体治疗下晶体液与胶体液输注对肝切除术患者组织灌注和术后恢复的影响 |
| Effects of goal-directed fluid therapy filled with crystalliods or colliods on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy |
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| DOI： |
| 中文关键词: 目标导向液体治疗 每搏量变异度 晶体液 胶体液 肝切除术 |
| 英文关键词: Goal-directed fluid therapy Stroke volume variation Crystalloids Colloids Hepatectomy |
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| 中文摘要: |
| 目的 比较目标导向液体治疗下晶体液与胶体液在择期肝切除术中的应用价值。方法 选择择期全麻下行肝切除术患者70例，男42例，女28例，年龄18～65岁，ASA Ⅱ或Ⅲ级，随机分为三组：常规液体治疗组(C组，n＝24)、目标导向胶体液组(G1组，n＝23)和目标导向晶体液组(G2组，n＝23)。C组主要根据MAP进行术中液体管理，G1、G2组桡动脉连接Flotrac/Vigileo系统监测每搏量变异度(SVV)和心脏指数(CI)，术中以MAP、SVV和CI为指导行目标导向液体治疗。当SVV>13%，G1组给予250 ml胶体液快速填充，G2组则给予相同容量晶体液快速填充；当CI<2.5 L·min-1·m-2则给予多巴酚丁胺20～100 μg·kg-1·min-1 持续泵注直至CI≥2.5 L·min-1·m-2。检测麻醉诱导前5 min(T1)、肝脏切除前5 min(T2)、肝脏切除后5 min(T3)和手术结束时(T4)的中心静脉氧饱和度(ScvO2)、乳酸(Lac)和血糖(Glu)浓度。记录手术时间、液体出入量及术中血管活性药物使用情况。记录排气时间、下床时间和术后住院时间，记录术前、术后肝肾功能指标及术后并发症发生情况。结果 与C组比较，G1组晶体液、胶体液和总液体用量明显减少(P<0.05)，排气时间、下床时间、术后住院日明显缩短(P<0.05)，T3、T4时ScvO2明显升高，Glu浓度明显降低，T2～T4时Lac浓度明显降低(P<0.05)，术后第3、5天ALT和AST浓度明显降低(P<0.05)。与G1组比较，G2组晶体液用量明显增加，恶心呕吐发生率明显升高(P<0.05)。两组排气时间、下床时间、术后住院时间、肝肾功能差异无统计学意义。结论 肝切除术中运用目标导向液体治疗策略可能有助于改善微循环和组织氧合、保护肝功能、促进胃肠功能恢复、缩短术后住院时间。与晶体液比较，采用胶体液填充可以降低术后恶心呕吐发生率，而在组织灌注和术后恢复等方面未见明显差异。 |
| 英文摘要: |
| Objective To compare the difference between crystalloids and colloids under goal-directed fluid therapy (GDFT) in elective hepatectomy. Methods Seventy patients undergoing hepatectomy, 42 males and 28 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ, were included and randomly divided into three groups base on fluid treatment: conventional fluid therapy (group C, n=24), goal-directed fluid therapy filled with colloids (group G1, n=23) and goal-directed fluid therapy filled with crystalloids (group G2, n=23). Group C received conventional fluid therapy mainly based on MAP while group G1 and group G2 received goal-directed fluid therapy based on MAP, stroke volume variation (SVV) and cardiac index (CI), and the Flotrac/Vigileo system was used to obtain SVV and CI in group G1 and group G2. 250 ml colloids were administered if SVV＞13% in group G1 while 250 ml crystalloids were administered in group G2. If CI<2.5 L·min-1·m-2, dobutamine 2.0-10.0 μg·kg-1·min-1 was given until CI≥2.5 L·min-1·m-2. The ScvO2, Lac and Glu were tested at 5 min before anesthesia induction (T1), 5 min before hepatectomy (T2), 5 min after hepatectomy (T3) and the end of operation (T4). The duration of operation, fluid requirement, urinary output, bleeding volume, and the use of vasoactive agent were recorded. The exhaust time, ambulation time and postoperative hospital stay were recorded. Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up. Results Compared with group C, the total volume was lower, flatus time, ambulation time and postoperative hospital stay were shorter, ScvO2 at T3 and T4 were higher, Lac at T2-T4 were lower, Glu at T3 and T4 were lower, ALT and AST on the third day and the fifth day after surgery were lower in group G1 (P<0.05). Compared with group G1, the amount of crystalloids was increased, the incidences of postoperative nausea and vomiting were significantly higher in group G2 (P<0.05). There was no significant difference in flatus time, ambulation time and postoperative hospital stay between group G1 and group G2. Conclusion GDFT in hepatectomy propably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay. GDFT using colloids bolus contribute to a much lower incidence of postoperative nausea and vomiting. There is no significant difference in tissue perfusion and postoperative recovery between colloids and crystalloids. |
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