每搏量变异度联合心指数在非重症肠道肿瘤患者术中容量治疗的研究

Adoption of stroke volume variation and cardiac index to guide volume therapy in unsevere intestinal neoplasm surgery cases

目的观察以每搏量变异度(SVV)联合心指数(CI)作为首要判断指标的目标导向液体治疗方案在非重症肠道肿瘤手术患者中的应用情况。方法择期全麻下行肠道肿瘤切除手术患者50例,ASAⅠ-Ⅱ级,年龄26～55岁,随机分为以CI为首要判断指标组(C组)和SVV联合CI为首要判断指标组(S组),C组以CI≥2.5 L/(min·m)为目标指导容量管理,S组根据SVV <12%及CI≥2.5 L/(min·m)联合判断。记录麻醉诱导后15 min(T_1)、切皮时(T_2)、肠吻合时(T_3)、关腹后(T4),MAP、HR、CVP、CI、SVV的变化。监测T1、T4时血乳酸(Lac)、氧供(DO_2)、氧耗(VO_2)及氧摄取率(ERO_2)。记录液体量、心血管不良事件、排气时间、住院时间及并发症的发生情况。结果与C组比较,S组输注胶体液量增多,晶体液量减少,低血压发生率降低(P <0.05),T4时DO_2、VO_2均增高、Lac降低(P <0.05),排气时间及住院时间缩短(P <0.05)。结论 SVV联合CI共同作为首要判断指标的方案可维持更平稳的血流动力学及更好的组织灌注,有助于改善预后,更适用于非重症患者。

Objective To observe the application of stroke volume variation(SVV)and cardiac index(CI)as the primary judgment in the goaldirected fluid therapy(GDT)in unsevere intestinal neoplasm surgery cases.Methods 50 patients(ASAⅠ-Ⅱ,26~55 years old)scheduled for intestinal neoplasm surgery were divided randomLy into 2 groups:group C used CI as the primary judgment indicator for GDT and group S used both SVV and CI as the primary judgment indicator.The patients in group C received the therapy with the goal to keep CI no less than 2.5 L/(min·m)and patients in group S to keep SVV<12%and CI no less than 2.5 L/(min·m).HR,MAP,CVP,CI,SVV were recorded 15 minutes after the induction of anesthesia(T1),surgical incision(T2),intestinal anastomosis(T3)and the abdominal incision close(T4).Oxygen delivery(DO2),oxygen consumption(VO2),O2 extraction rate(ERO2)and plasma Lactic acid(Lac)were monitored at T1 and T4.The volume of fluid,the incidence of adverse cardiovascular events,the exhaust time,hospital stays and complications were recorded.Results Patients in group S reported the increased amount of colloidal fluid,decreased crystalline fluid,lower in?cidence of hypotension than group C.DO2,VO2 were increased and Lac decreased at T4 in group S.The exhaust time and hospital stay were reduced in group S(P<0.05).Conclusions GDT using SVV and CI as the primary judgment maintained reports more stable hemodynamic and better tissue perfusion,which helps to improve the prognosis of patients.This protocol is more suitable for patients with unsevere conditions.