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| 下腔静脉扩张指数指导液体管理改善经尿道前列腺切除术患者早期预后 |
| Inferior vena cava distensibility index in guiding fluid management to improve the early prognosis of patients undergoing transurethral resection of prostate |
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| DOI：10.12089/jca.2021.05.008 |
| 中文关键词: 下腔静脉扩张指数 液体管理 前列腺切除术 呼吸系统不良事件 苏醒期谵妄 |
| 英文关键词: Inferior vena cava distensibility index Fluid management Resection of prostate Respiratory adverse events Emergence delirium |
| 基金项目:国家自然科学基金（81701050）；江苏省卫生健康委员会科研项目（H2017038） |
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| 中文摘要: |
目的 探讨下腔静脉扩张指数（dIVC）指导液体管理对经尿道前列腺切除术（TURP）患者早期预后的影响。
方法 选择2019年11月至2020年9月择期全麻下行TURP的男性患者80例，年龄60~80岁，BMI 18~30 kg/m2，ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组：dIVC指导液体管理组（G组）和传统液体管理组（C组），每组40例。G组采用dIVC指导液体管理，术中维持dIVC≤18%；C组采用传统“4-2-1”补液法则进行液体管理。记录术前、术后1 h血乳酸浓度和血钠浓度。记录术中晶体液输入量、术中去甲肾上腺素使用率、手术时间、PACU内留观时间、术后住院时间、PACU内呼吸系统不良事件和苏醒期谵妄、恶心呕吐发生率。
结果 与术前比较，术后1 h G组血乳酸浓度明显降低（P<0.05）。与C组比较，G组PACU内留观时间明显缩短（P<0.05），术后1 h血乳酸浓度明显降低（P<0.05），术中晶体液输入量明显减少（P<0.05），术中去甲肾上腺素使用率明显升高（P<0.05），PACU内呼吸系统不良事件和苏醒期谵妄发生率明显降低（P<0.05）。
结论 TURP采用dIVC指导液体管理可以减少患者术中晶体液输入量，减少PACU内呼吸系统不良事件和苏醒期谵妄发生，改善患者早期预后。 |
| 英文摘要: |
Objective To investigate the effect of inferior vena cava distensibility index (dIVC) in guiding fluid management on the early prognosis of patients undergoing transurethral resection of prostate (TURP).
Methods Eighty patients undergoing TURP under general anesthesia from November 2019 to September 2020, aged 60-80 years, BMI 18-30 kg/m2, ASA physical status Ⅱ or Ⅲ, were included in the study and randomly divided into two groups using random number table: dIVC guided fluid management group (group G) and traditional fluid management group (group C), 40 patients in each group. Group G used the dIVC to guide fluid management, and dIVC was maintained ≤ 18% during surgery. Group C used the traditional “4-2-1” rehydration rule for fluid management. The concentrations of blood lactic acid and sodium preoperation and 1 hour postoperation, the intraoperative volume of fluid infusion, the usage of norepinephrine, the operation time, the observation time in PACU, the postoperative hospital stay, the incidence of respiratory adverse events and emergence delirium in PACU, and the incidence of nausea and vomiting were recorded.
Results Compared with preoperation, the concentration of blood lactic acid at 1 hour after surgery in group G was significantly lower (P < 0.05). Compared with group C, the observation time in PACU was shortened in group G (P < 0.05), the concentration of blood lactic acid 1 hour postoperation in group G was significantly lower (P < 0.05), the intraoperative volume of fluid infusion in group G was significantly decreased (P < 0.05), the usage of norepinephrine in group G was significantly increased (P < 0.05), and the incidence of respiratory adverse events and emergence delirium in PACU was significantly decreased in group G (P < 0.05).
Conclusion The use of dIVC in guiding fluid management during TURP can reduce the intraoperative volume of fluid infusion, decrease the incidence of respiratory adverse events and emergence delirium in PACU and improve the early prognosis of patients． |
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