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| Flotrac/Vigileo监测下的输液策略对妇科腹腔镜手术患者脑循环的影响 |
| Effect of infusion strategies under Flotrac/Vigileo monitor on cerebral circulation in gynecological laparoscopic surgery patients |
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| DOI：10.12089/jca.2019.05.015 |
| 中文关键词: 气腹；脑血流；颅内压 输液策略 |
| 英文关键词: Pneumoperitoneum Cerebral blood flow Intracranial pressure Infusion strategy |
| 基金项目:内蒙古自治区人民医院院内基金（2016034） |
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| 中文摘要: |
目的 探讨Flotrac/Vigileo监测下的输液策略对脑血流动力学和颅内压的影响。
方法 选择择期妇科腹腔镜子宫切除术患者60例，年龄36~59岁，体重55~75 kg，ASAⅠ或Ⅱ级，随机分为Vigileo组（Ａ组）和对照组（Ｃ组），每组30例。两组患者均采用常规麻醉诱导气管插管全麻。A组根据Vigileo的
结果 给予液体输注，C组根据421法则进行液体输注。记录两组患者麻醉诱导前（T0）、 气腹后10 min（T1）、 30 min（T2）和60 min（T3）时经颅多普勒超声仪测定患者大脑中动脉搏动指数（PI）和阻力指数（RI），脑水肿测定仪检测扰动系数的变化。
结果 与T0时比较，T3时两组PI和RI明显升高，T1—T3时两组扰动系数明显升高（P＜0.05）；与C组比较，T3 时A组PI和RI明显降低，T2、T3时A组扰动系数明显降低（P＜0.05）。
结论 术中利用Vigileo精细化液体管理，可以降低妇科腹腔镜手术患者的脑水肿程度，缓解颅内压增高，更有利于维持相对稳定的脑循环。 |
| 英文摘要: |
Ojective To explore the effects of infusion strategies under Flotrac/Vigileo monitoring on cerebral hemodynamics and intracranial pressure (ICP).
Methods Sixty patients with selective gynecological laparoscopic hysterectomy, aged 36 - 59 years, weighing 55 - 75 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into vigileo group (group A) and control group (group C), with 30 cases in each group. Patients in both groups were given endotracheal intubation under general anesthesia. Group A was given liquid infusion according to the results of Vigileo, while group C was given liquid infusion according to rule 421. Middle cerebral artery pulse index (PI) and resistance index (RI) were measured by the transcranial doppler ultrasonography before anesthesia induction (T0), 10 min (T1), 30 min (T2) and 60 min (T3) after pneumoperitoneum. Cerebral edema disturbance factor was detected by noninvasive brain edema tester in the two groups.
Results The middle cerebral artery PI and RI increased in groups A and C at T0 compared with that at T3, and disturbance factor increased too between T1 - T3(P ＜ 0.05). Meanwhile, the middle cerebral artery PI and RI in group A were significantly lower than that in group C at T3, while disturbance factor obviously decreased at T2 and T3(P＜0.05).
Conclusion The degree of cerebral edema can be reduced and intracranial hypertension can be relieved using Vigileo fluid management in patients undergoing gynecological laparoscopic surgery, which could be more conducive to maintaining relatively stable cerebral circulation. |
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