文章摘要
目标导向液体治疗对老年单肺通气患者局部脑氧饱和度及血流动力学的影响
Effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation in the elder patient undergoing one-lung ventilation
  
DOI：
中文关键词: 目标导向液体治疗  每搏量变异度  单肺通气  脑氧饱和度
英文关键词: Goal-directed fluid therapy  Stroke volume variation  One-lung ventilation  Cerebral oxygen saturation
基金项目:安徽省科技厅对外合作项目(1503062021)
作者单位E-mail
汪悦 230071,合肥市,安徽医科大学附属省立医院南区麻醉科  
李娟 230071,合肥市,安徽医科大学附属省立医院南区麻醉科 huamuzi1999@126.com 
康芳 230071,合肥市,安徽医科大学附属省立医院南区麻醉科  
黄祥 230071,合肥市,安徽医科大学附属省立医院南区麻醉科  
韩明明 230071,合肥市,安徽医科大学附属省立医院南区麻醉科  
冯芳 230071,合肥市,安徽医科大学附属省立医院南区麻醉科  
摘要点击次数: 3341
全文下载次数: 1574
中文摘要:
      
目的 观察目标导向液体治疗(goal-directed fluid therapy，GDFT)对老年单肺通气患者局部脑氧饱和度(rSO2)及血流动力学的影响。
方法 选择择期全麻下行中段食管癌根治术患者58例，男44例，女14例，年龄65～79岁，ASA Ⅱ或Ⅲ级，采用随机数字表法分为两组：传统液体治疗组(C组)和GDFT组(G组)，每组29例。所有患者均通过桡动脉连接FloTrac/Vigileo监测系统连续监测MAP、心输出量(CO)、心脏指数(CI)和每搏量变异度(SVV)。C组根据MAP、CVP及尿量行传统液体疗法；G组于SVV指导下行GDFT，维持CI 2.5～4.0 L·min-1·m-2。所有患者于术中持续监测rSO2，计算术中rSO2平均值(rSO2)、术中rSO2最小值(rSO2min)以及rSO2较基础值下降的最大百分比(rSO2%max)；记录入室建立监测后(T1)、单肺通气前(T2)、单肺通气30min(T3)、单肺通气1h(T4)及术毕(T5)时的MAP、HR、CVP、CI及SVV；记录术中晶体液和胶体液用量、总输液量、出血量、尿量以及血管活性药物的使用情况。
结果与C组比较，T3、T4时G组MAP明显升高(P<0.05)；T3～T5时G组CVP明显下降、CI明显升高(P<0.05)；T2～T5时G组SVV明显下降(P<0.05)。G组rSO2%max明显低于C组(P<0.05)，两组rSO2和rSO2min差异无统计学意义。与C组比较，G组术中晶体液用量[(668±187)ml vs (1 052±221)ml]、总输液量[(1 212±318)ml vs (1 519±329) ml]、尿量[(211±47) ml vs (278±54) ml]及血管活性药物使用[4例(14%) vs 14例(48%)]明显减少（P<0.05），胶体液用量明显增加[(544±103) ml vs (467±94) ml，P<0.05]。
结论 基于SVV的GDFT可稳定老年患者单肺通气时的血流动力学，维持脑氧供需稳定。
英文摘要:
      
Objective To observe the effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation (rSO2) in the elder patient undergoing one-lung ventilation.
Methods Fifty-eight patients scheduled for esophagus cancer resection(44 males,14 females, aged 65-79 years, ASA physical status Ⅱ or Ⅲ), were randomly divided into two groups (n=29 each) using a random number table: conventional fluid therapy group (group C) and goal-directed fluid therapy group (group G). Implementing radial artery puncture and internal jugular vein puncture under local anesthesia in order to monitor BP and CVP. TheFlotrac/Vigileosystemwasused tomonitor cardiac output (CO), stroke volume variation (SVV) and cardiac index (CI) in the both group. As mentioned all above, group C received conventional fluid therapy based on MAP, CVP and urine volume, whereas group G received goal-directed fluid therapy (GDFT) based on SVV with the goal of CI at 2.5-4.0 L· min-1·m-2. Intraoperative continuous monitoring of rSO2 was performed and the surgery rSO2 average (rSO2), the minimal surgery rSO2(rSO2min) and the maximal percentage of the decreased rSO2 compared to baseline values (rSO2%max) were calculated in the both group. The variation of MAP, HR, CVP, SVV and CI at the onset of the monitoring (T1), the momment before one-lung ventilation (T2), 30 min after one-lung ventilation (T3), 1 h after one-lung ventilation(T4) and the end of the surgery (T5) were recorded. The requirement for crystalloid and colloid, total volume of fluid infused, bleeding volume, urine volume, and requirement for vasoactive agents were recorded during operaton.
Results Compared with group C, MAP at T3, T4 and CI at T3-T5 in group G were increased significantly, while CVP at T3-T5 and SVV at T2-T5 in group G were decreased (P<0.05). The rSO2%maxin group G was significantly lower than that in group C (P<0.05). No statistically significant difference was observed in the rSO2 and rSO2min between the two groups. Compared with group C, the requirement for crystalloid [(668±187)ml vs (1 052±221)ml and total volume of fluid infused [(1 212±318)ml vs (1 519±329) ml], urine volume [(211±47) ml vs (278±54) ml] and vasoactive agents [4 cases (14%) vs 14 cases (48%)] were significantly decreased (P<0.05), the requirement for colloid were increased [(544±103) ml vs (467±94) ml,P<0.05].
Conclusion The goal-directed fluid therapy based on SVV stabilizes the hemodynamic effectively, improves the CI and the perfusion of brain, and maintains the cereral oxygen metabolism in the elder patient undergoing one-lung ventilation.
查看全文   查看/发表评论  下载PDF阅读器
关闭