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| 目标导向液体治疗对脊柱手术老年患者预后的影响 |
| Effect of goal-directed fluid therapy on the outcomes of elderly patients undergoing spinal surgery |
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| DOI：10.12089/jca.2018.07.006 |
| 中文关键词: 目标导向液体治疗 脉压变异率 脊椎手术 预后 |
| 英文关键词: Goal-directed fluid therapy Pulse pressure variation Spinal surgery Outcomes |
| 基金项目:国家老年疾病临床医学研究中心, 北京市卫生和计划生育委员会“老年重大疾病关键技术研究”(PXM2017_026283_000002);临床医学发展专项经费(扬帆计划)(ZYLX201818) |
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| 中文摘要: |
目的 观察以脉压变异率(PPV)为目标的液体导向治疗(goal-directed fluid therapy, GDFT)对脊柱手术的老年患者预后的影响。
方法 选择择期行全身麻醉下脊柱手术的老年患者520例, 男250例, 女270例, 年龄65～93岁, BMI18.5～34.0 kg/m2, ASAⅡ或Ⅲ级。采用随机数字法分为两组: 目标导向液体治疗组(G组)和常规输液组(C组), 每组260例。G组以PPV为目标, 根据GDFT方案对患者进行容量管理, C组麻醉科医师根据经验进行液体管理。记录术前1 d (T0)、麻醉诱导前(T1)、手术开始即刻(T2)、手术结束即刻(T3)的HR、MAP、脉压变异率(PPV)。记录手术时间、术中晶体液的输入量、胶体液输入量、输液总量、自体血回输量、出血量、尿量、麻黄碱使用例数和去甲肾上腺素使用例数。记录术后住院时间, 恶心呕吐、头晕、伤口感染、肺部感染和发热等术后并发症情况。
结果 T3时G组PPV明显低于C组(P<0.05)。两组不同时点HR和MAP差异无统计学意义。G组晶体液输入量明显少于C组(P<0.05), 术中去甲肾上腺素使用率明显低于C组(P<0.05)。两组胶体液输入量、输液总量、自体血回输量、出血量、尿量和麻黄碱使用率差异无统计学意义。G组术后住院时间明显短于C组(P<0.05)。G组发热病例明显少于C组(P<0.05)。
结论 以PPV为目标导向的液体治疗可以减少脊柱手术老年患者术中晶体液的输入量, 血流动力学稳定性好, 减少术后并发症的发生, 缩短术后住院时间。 |
| 英文摘要: |
Objective To evaluate the efftct of goal-directed fluid therapy(GDFT) targeting pulse pressure variation(PPV) on the outcomes of elderly patients undergoing spinal surgery.
Methods A total of 520 elderly patients scheduled for spinal surgery under general anesthesia, including 250 males and 270 females, aged 65 to 93 years, BMI 18.5 to 34.0 kg/m2, and ASA physical status Ⅱ to Ⅲ, were randomly divided into two groups: goal-directed fluid therapy group (group G) and conventional fluid therapy group (group C), 260 patients in each group. Patients were allocated to either GDFT or anesthesiologist-directed fluid therapy. HR, MAP and pulse pressure variability (PPV) were recorded at 4 time points: 1 d before surgery (T0), before induction of anesthesia (T1), before the surgery (T2), and end of the surgery (T3). The operative time, the requirement for crystalloid and colloid, total volume of fluid infused, bleeding volume, urine volume and vasoactive agents were recorded. Postoperative hospital stay, postoperative complications such as nausea and vomiting, dizziness, wound infection, pulmonary infection, and fever were collected and recorded.
Results The PPV in group G was significantly lower than that in group C at T3 (P < 0.05). There was no statistically significant difference in HR and MAP between the two groups at each time point. The volume of crystalloid fluid in group G was significantly lower than that in group C (P < 0.05). The use of norepinephrine was significantly lower in group G than in group C (P < 0.05). No statistically significant difference was observed in the colloidal fluid input, total infusion volume, autologous blood transfused volume, bleeding volume, urine volume and ephedrine use cases between the two groups. The postoperative hospital stay was significantly shorter in group G than in group C (P < 0.05). The febrile cases in group G was significantly less than that in group C (P < 0.05).
Conclusion The goal-directed fluid therapy based on PPV can reducethe volume of crystal fluid input and the number of postoperative complications in elderly patients undergoing spinal surgery. It has good hemodynamic stability, and shortens postoperative hospital stay. |
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