文章摘要
低每搏量变异度指导的目标导向液体治疗对沙滩椅位患者血流动力学及脑氧饱和度的影响
Effects of goal-directed fluid therapy guided by low stroke volume variation levels on hemodynamics and cerebral oxygen saturation in patients in the beach chair position
  
DOI：10.12089/jca.2025.05.002
中文关键词: 每搏量变异度  目标导向液体治疗  沙滩椅位  肩关节镜  血流动力学  脑氧饱和度
英文关键词: Stroke volume variation  Goal-directed fluid therapy  Beach chair position  Shoulder arthroscopy  Hemodynamics  Cerebral oxygen saturation
基金项目:中关村精准医学基金会（320.2120.2024.0723.011）
作者单位E-mail
郑晓静 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
许辉 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
疏树华 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 sshhf@189.cn 
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中文摘要:
      
目的：评价低每搏量变异度（SVV）指导的目标导向液体治疗（GDFT）对沙滩椅位肩部手术患者围术期血流动力学及局部脑氧饱和度（rScO2）的影响。
方法：选择2023年3月至2024年3月择期在沙滩椅位下行肩关节镜手术患者60例，男18例，女42例，年龄18～64岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：低SVV组（L组）和高SVV组（H组），每组30例。L组SVV目标值范围为6%～9%，H组SVV目标值范围为10%～13%。记录入手术室后（T1）、麻醉诱导后5 min（T2）、到达SVV目标值范围后10 min（T3）、体位变为沙滩椅位后10 min（T4）和手术结束即刻（T5）HR、MAP、心输出量(CO)、每博量(SV)和全身血管阻力(SVR)。记录术中尿量、失血量、晶体输入量、胶体输入量、输液总量、去甲肾上腺素用量、手术时间。术中持续监测rScO2，记录rScO2基础值(rScO2base)并计算术中平均rScO2值（rScO2mean）、最小rScO2值（rScO2min）以及rScO2较基础值下降的最大百分比（rScO2%max）。于T2、T3和T5时进行动脉血气分析并记录乳酸浓度。记录术后2 d心血管并发症（高血压、低血压、心律失常、心肌缺血、心功能不全）、神经系统并发症（脑卒中、术后认知功能障碍）、肺部并发症（肺部感染、肺水肿、肺不张）、少尿和无尿的发生情况。
结果：与H组比较，L组T4时MAP、CO、SV、术中rScO2mean和rScO2min明显升高（P<0.05），术中晶体输入量、胶体输入量、输液总量明显增多（P<0.05），术中去甲肾上腺素用量明显减少，T5时乳酸浓度明显降低（P＜0.05）。术后2 d两组无一例心血管并发症、神经系统并发症、肺部并发症以及少尿和无尿的发生。
结论：采用SVV 6%～9%为指导的GDFT更有利于稳定由于沙滩椅位造成的血流动力学波动，改善脑部低灌注，且无相关并发症发生。
英文摘要:
      
Objective: To evaluate the impact of goal-directed fluid therapy (GDFT) guided by low stroke volume variation (SVV) levels on perioperative hemodynamics and regional cerebral oxygen saturation (rScO2) in patients undergoing shoulder surgery in the beach chair position.
Methods: Sixty patients scheduled for elective shoulder arthroscopy in the beach chair position from March 2023 to March 2024, 18 males and 42 females, aged 18-64 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were selected for this study. The patients were randomly divided into two groups through a random number table: the low SVV group (group L) and the high SVV group (group H), 30 patients in each group. The SVV target range in group L was established at 6%-9%, while it was set at 10%-13% in group H. The HR, MAP, cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were recorded after entering the operating room (T1), 5 minutes after anesthesia induction (T2), 10 minutes after reaching the target stroke volume variation (SVV) range (T3), 10 minutes after changing to the beach chair position (T4), and immediately at the end of the surgery (T5). The intraoperative urine output, blood loss, crystalloid and colloid inputs, total infusion volume, norepinephrine dosage, and the duration of the surgery were documented. The rScO2 were monitored continuously during surgery. The rScO2 baseline values (rScO2base) were recorded, calculations were made for the average intraoperative rScO2 (rScO2mean), the minimum rScO2 (rScO2min), and the maximum rScO2 percentage decline from baseline (rScO2%max). Arterial blood gas analysis was conducted and the concentration of lactate were recorded at T2, T3, and T5. The incidence of cardiovascular complications such as hypertension, hypotension, arrhythmias, myocardial ischemia, and heart failure, neurological complications such as stroke and postoperative cognitive dysfunction, and pulmonary complications such as pulmonary infection, pulmonary edema, and atelectasis, along with oliguria and anuria were recorded 2 days after surgery.
Results: Compared with group H, MAP, CO, SV, rScO2mean, and rScO2min at T4, the volume of crystalloid and colloid infusion, and the total fluid intake were significantly increased (P < 0.05), the norepinephrine dosage administered and the concentration of lactate at T5 were significantly decreased in group L (P < 0.05). There were no patients occuerred cardiovascular complications, neurological complications, pulmonary complications, oliguria, or anuria in the two groups 2 days after surgery.
Conclusion: Implementing GDFT guided by SVV at 6%-9% proves to stable hemodynamic fluctuations and improve cerebral hypoperfusion associated with the beach chair position. This approach shows no related complications, highlighting its clinical application value.
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