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| 允许性高每搏量变异度在老年患者腹腔镜肝切除术中的应用 |
| Application of permissible high stroke volume variation in elderly patients undergoing laparoscopic hepatectomy |
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| DOI：10.12089/jca.2022.04.003 |
| 中文关键词: 每搏量变异度 腹腔镜肝脏手术 目标导向液体治疗 中心静脉压 老年 |
| 英文关键词: Stroke volume variation Laparoscopic liver surgery Goal-directed fluid therapy Central venous pressure Aged |
| 基金项目:承德市科学技术研究与发展计划项目（201904A044） |
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| 中文摘要: |
目的探讨允许性高每搏量变异度（SVV）在老年患者腹腔镜肝切除术中的应用效果。
方法选择2020年8月至2021年8月拟行腹腔镜肝脏切除手术的患者100例，男67例，女33例，年龄65～80岁，BMI 18～25 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：以SVV指导补液的研究组（S组）和以CVP指导补液的对照组（C组），每组50例。S组：第1阶段以允许性高SVV值（13%～20%）行液体治疗，第2阶段以SVV（9%～13%）为目标进行补液；C组：第1阶段以低CVP值（0～5 cmH2O）行液体治疗，第2阶段以CVP（5～12 cmH2O）为目标进行补液。记录第1、2阶段持续时间、血管活性药使用情况、术中出血量、输液量、尿量、术毕乳酸浓度。记录入室、切皮、开始切肝、切肝完成、术毕的HR、MAP。持续记录术中脑氧饱和度（rSO2），计算术中rSO2平均值（rSO2mean)、术中rSO2最小值（rSO2min）、rSO2较基础值下降的最大百分比（rSO2%max）。记录术前1 d、术后1、2、3 d的肌酐（Cr）、尿素氮（BUN）。
结果S组去氧肾上腺素、硝酸甘油使用率明显低于C组（P<0.05），S组术中出血量明显少于C组（P<0.05），术中输液量、尿量明显多于Ｃ组（P<0.05），术毕时S组血清乳酸浓度明显低于C组（P<0.05）。与C组比较，在开始切肝、切肝完成时S组HR明显减慢(P<0.05)，MAP明显升高（P<0.05）。S组rSO2%max明显低于C组（P<0.05）。术后1、2、3 d S组Cr明显低于C组（P<0.05）。
结论在腹腔镜肝切除术中采用允许性高SVV指导目标导向液体治疗，可减少术中出血，维持血流动力学稳定，保证重要脏器的血液灌注。 |
| 英文摘要: |
Objective To investigate the application of permissible high stroke volume variation (SVV) in elderly patients undergoing laparoscopic hepatectomy.
Methods A total of 100 patients, 67 males and 33 females, aged 65-80 years, BMI 18-25 kg/m2, ASA physical status Ⅱ or Ⅲ, who were scheduled for laparoscopic hepatectomy from August 2020 to August 2021 were selected. The patients were divided into two groups by random number table method: experimental group guided by SVV (group S) and control group guided by central venous pressure (CVP) (group C), 50 patients in each group. Group S: in the first stage, high allowable SVV (13%-20%) was treated with fluid, and in the second stage, SVV (9%-13%) was treated with fluid. Group C: in the first stage, low CVP value (0-5 cmH2O) was treated with fluid, and in the second stage, CVP value (5-12 cmH2O) was treated with fluid. Duration of the first stage and second stage, the use of vasoactive drugs, the intraoperative blood loss, transfusion volume, urine volumeand lactic acid concentrationwere recorded. HR and MAP of patients entering the room, cutting skin, beginning of liver resection, completing of liver resection, and finishing operation were recorded. Regional cerebral oxygen saturation (rSO2) was continuously recorded, and the average value of rSO2(rSO2mean) during operation, the minimum value of rSO2(rSO2min) during operation, and the maximum percentage of rSO2 decreasing compared with the basic value (rSO2%max) were calculated. Cr and BUN were recorded 1 day before operation and 1, 2, 3 days after operation.
Results The rate of using norepinephrine and nitroglycerin in group S were significantly lower than those in group C (P < 0.05). The intraoperative blood loss in group S were significantly lower than that in group C (P < 0.05), and intraoperative fluid volume and urine volume were significantly higher than those in group C (P < 0.05). After operation, serum lactic acid concentration in group S was significantly lower than that in group C (P < 0.05). At the beginning of liver resection and at the end of liver resection, compared with group C, HR in group S was significantly slower and MAP was significantly higher (P < 0.05). Compared with group C, rSO2%max and Cr in group S was significantly lower (P < 0.05).
Conclusion Goal-directed fluid therapy (GDFT) with high SVV in laparoscopic hepatectomy can ensure blood perfusion in important organs, maintain hemodynamic stability, reduce intraoperative bleeding. |
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