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| 下腔静脉塌陷指数指导的目标导向液体治疗对高龄患者髋部手术中低血压的影响 |
| Effect of goal-directed fluid therapy on hip operative hypotensien in elderly patients with inferior vena cava collapsibility index monitored |
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| DOI：10.12089/jca.2025.04.005 |
| 中文关键词: 髋部手术 老年 目标导向液体治疗 下腔静脉塌陷率 低血压 |
| 英文关键词: Hip operation Aged Goal-directed fluid therapy Inferior vena cava collapsibility index Hypotension |
| 基金项目:陕西省卫生健康老年髋膝关节置换加速康复科研创新团队项目（2024TD-02）；延安市基于ERAS下临床麻醉管理科技创新团队项目（2021-21） |
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| 中文摘要: |
目的：探讨超声监测下腔静脉塌陷指数（IVC-CI）指导的目标导向液体治疗（GDFT）对高龄患者髋部手术低血压及血流动力学的影响。
方法：选择择期腰-硬联合阻滞下行髋部手术的高龄患者100例，男34例，女66例，年龄75～90岁，ASA Ⅱ 或 Ⅲ 级。将患者随机分为两组：超声监测IVC-CI指导的GDFT组（GF组）和常规液体治疗组（CF组），每组50例。GF组由麻醉科医师通过超声监测IVC-CI评估容量状态，对患者进行GDFT，直至下腔静脉直径>1 cm且IVC-CI<42%；CF组由麻醉科医师依照生理需要量、术前丢失量、术中出血量及尿量给予经验性补液治疗。记录术中低血压发生情况，术后24 h内低血压发生情况，术中和术后24 h内出入量包括液体总入量、输液量、血制品输入情况、尿量，术后新发并发症包括肺部感染、肺水肿、急性肾损伤、恶心呕吐、伤口延迟愈合等发生情况，心脑血管事件包括硬膜下血肿、心力衰竭、脑梗死、下肢静脉血栓形成等发生情况。
结果：与CF组比较，GF组术中低血压发生率和术后24 h内低血压发生率明显降低（P＜0.05），住院时间明显缩短（P＜0.05），术中液体总入量、输液量明显增多（P＜0.05），术后液体总入量、输液量明显减少（P＜0.05）。两组术中和术后血制品输入情况、尿量差异无统计学意义。两组肺部感染、肺水肿、急性肾损伤、恶心呕吐、伤口延迟愈合、硬膜下血肿、心力衰竭、脑梗死、下肢静脉血栓形成等差异无统计学意义。
结论：与常规液体治疗比较，通过超声监测下腔静脉塌陷指数进行目标导向液体治疗能降低高龄患者髋部手术患者术中及术后24 h内低血压的发生，缩短住院时间。 |
| 英文摘要: |
Objective: To explore the influence of goal-directed fluid therapy (GDFT) on hip operation cycle in elderly patients with inferior vena cava collapsibility index (IVC-CI) monitored by ultrasound.
Methods: A total of 100 elderly patients, 34 males and 66 females, aged 75-90 years, ASA physical status Ⅱ or Ⅲ, were selected for elective hip surgery under intraspinal anesthesia. Patients were randomly divided into two groups: GDFT group with ultrasonic monitoring of IVC-CI (group GF) and conventional fluid therapy group (group CF), 50 patients in each group. In group GF, the anesthesiologist evaluated the volume status by ultrasonic monitoring of IVC-CI, and GDFT was performed until the inferior vena cava diameter was greater than 1 cm and the IVC-CI was less than 42%; in group CF, the anesthesiologist gave empirical fluid therapy according to physiological needs, preoperative loss, intraoperative blood loss and urine volume. The incidence of intraoperative hypotension and the incidence of postoperative hypotension within 24 hours after surgery were recorded. Data were recorded during operation and 24 hours after operation, including total fluid intake, infusion volume, blood products, and urine output. The incidence of new-onset postoperative complications, such as pulmonary infection, pulmonary edema, acute kidney injury, nausea and vomiting, and delayed wound healing, was recorded. The occurrence of cardiovascular and cerebrovascular events, including subdural hematoma, heart failure, cerebral infarction, and deep vein thrombosis of the lower limbs was also recorded.
Results: Compared with group CF, the incidence of intraoperative hypotension and 24 hours postoperative hypotension in group GF was significantly decreased (P < 0.05). The length of hospitalization was significantly shortened (P < 0.05), the total intraoperative fluid intake and infusion volume were significantly increased (P < 0.05), and the total postoperative fluid intake and infusion volume were significantly decreased (P < 0.05). There was no significant difference in blood products and urine output between the two groups. There were no significant differences in pulmonary infection, pulmonary edema, acute kidney injury, nausea and vomiting, delayed wound healing, subdural hematoma, heart failure, cerebral infarction, and deep vein thrombosis of the lower limbs between the two groups.
Conclusion: Compared with conventional fluid therapy, by monitoring the inferior vena cava collapsibility index with ultrasound, GDFT can reduce the incidence of intraoperative and postoperative hypotension 24 hours and shorten the length of hospital stay in elderly patients undergoing hip surgery. |
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