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| Vigileo和经食管超声心动图监测每搏量在腹腔镜手术容量输注中的比较 |
| Comparasion of stroke volume monitored by FloTrac/Vigileo under transesophageal echocardiography to guide capacity infusion during robot laparoscopic colorectal cancer surgery in elder patients |
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| DOI：10.12089/jca.2018.11.004 |
| 中文关键词: 食管超声 FloTrac/Vigileo 机器人腹腔镜术 直肠癌手术 每搏量 |
| 英文关键词: Transesophageal echocardiography FloTrac/Vigileo Laparoscopic robot Colorectal surgery Stroke volum |
| 基金项目:江西省卫生厅课题资助项目(20171031) |
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| 中文摘要: |
目的 比较Vigileo与经食管超声心动图（TEE）监测每搏量在直肠癌患者腹腔镜术中容量输注的研究。
方法 选择择期行机器人辅助下腹腔镜直肠癌患者30例, 年龄60～80岁,男17例，女13例，体重45～75 kg, ASA Ⅱ 或 Ⅲ 级。局麻下颈内静脉和桡动脉穿刺置管并连接Vigileo设备行每搏量(SV)监测。静脉给予丙泊酚1.5 mg/kg、阿曲库铵0.15 mg/kg、右美托咪定0.5 μg/kg、舒芬太尼0.3 μg/kg诱导后行气管插管, 使用丙泊酚, 顺式阿曲库铵及瑞芬太尼维持麻醉, 插入食管超声探头监测SV; 记录Vigileo与TEE于气管插管后4 min(T0)、气腹后4 min（T1）、气腹后8 min（T2）时获取得SV并采取Bland-Altman图评价两者的一致性。
结果 与T0时比较, T1、T2时Vigileo测量的SV(SVV)明显升高(P<0.05)，T2时食管超声测量的SV（SVT）明显升高（P<0.05）; 与T1时比较, T2时SVV和SVT均明显升高(P<0.05); T1、T2时SVV明显高于SVT(P<0.05);T0时Bland-Altman分析显示两种测量手段的一致性好;T1、T2时Bland-Altman分析显示两种测量手段的一致性较差。
结论 Vigileo于腔镜术中高循环阻力时监测SV较TEE监测更高,TEE测量SV具有可靠性、连续性、可重复性等特点，在临床运用具有明显的优势。 |
| 英文摘要: |
Objective To compare stroke volume monitored by FloTrac/Vigileo with stroke volume by intraoperative ultrasound of the esophagus to guide capacity infusion used in laparoscopic colorectal cancer surgery.
Methods Selecting 30 patients with elective robot assisted laparoscopic colorectal cancer, aged 60 to 80 years, 17 males, 13 females, weighing 45 to 75 kg, and falling into ASA physical status Ⅱ to Ⅲ, internal jugular vein puncture catheter under local anesthesia and arterial puncture with 22G catheter and connecting FloTrac/Vigileo equipment monitoring stroke volume (SV). 1.5 mg/kg propofol, 0.15 mg/kg cisatracurium besilate, dexmedetomidine 0.5 μg/kg, 0.3 μg/kg sufentanil were given to induceanesthesia. After the success of the endotracheal intubation, ultrasonic probe was inserted into esophagus to monitor the SV, 4 min after endotracheal intubation (T0), 4 min after the start of pneumoperitoneum (T1) and 8 min after the start of pneumoperitoneum (T2) SV value was obtained by FloTrac/Vigileo system and esophageal ultrasonic respectively, then through Bland-Altman plot the consistency was evaluated.
Results Compared with T0, SVV in T3 were higher (P < 0.05). Compared with T0, T1, value of SVT and SVV in T2 were higher (P < 0.05). In the same T1, T2, value of SVV were higher than SVT. Bland-Altman analysis in T0 showed that the consistency of the two kinds of measurements were good.
Conclusion Compared with TEE, SV monitored by Vigileo in high systemic vascular resistance during laparoscopic surgery wree higher. Stroke volume monitored by TEE has the characteristics of reliability, continuity and repeatability, and has obvious advantages in clinical application. |
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