目标导向液体治疗对腹部手术患者预后的影响

Effect of goal-directed fluid therapy on the prognosis of patients undergoing abdominal surgery

目的 探讨基于每搏量变异度的术中目标导向液体治疗对成年患者腹部手术预后的影响。方法 选择火箭军特色医学中心2016-01至2021-09行腹部手术并在术中接受有创动脉穿刺置管的患者,根据是否进行基于每搏量变异度(stroke volume variation, SVV)的液体治疗,将患者分为目标导向液体治疗组和常规液体输注组。比较患者ICU治疗时间、住院时间及术后30 d内病死率、术后恶心呕吐发生率、术中低血压、心动过速发生率、术中输液量和输血量。结果 共纳入患者1055例,其中目标导向液体治疗组713例,常规液体输注组342例。常规液体输注组液体输入量[(1611.26±828.40)ml]大于目标导向液体治疗组液体输入量[(1497.35±730.73)ml],两者比较具有统计学差异(P<0.05)。目标导向液体治疗组的ICU治疗时间为(1.93±3.77)d,住院时间为(30.20±17.40)d,术后30 d病死率为4.35%,术后恶心呕吐发生率为20.90%;常规液体输注组ICU治疗时间为(1.95±4.12)d,住院时间为(30.26±19.20)d,术后30 d病死率为5.26%,术后恶心呕吐发生率为25.73%,两组差异无统计学意义。结论 SVV监测下的目标导向液体治疗对腹部手术患者的预后无影响。

Objective To evaluate the effect of goal-directed intraoperative fluid therapy guided by stroke volume variation(SVV) on adult patients who underwent abdominal surgery.Methods Patients undergoing abdominal surgery with arterial puncture placement intraoperatively from January 2016 to September 2021 in Characteristic Medical Center of PLA Rocket Force were selected and divided into goal-directed fluid therapy(GDFT) group and conventional fluid infusion(CFI) group according to SVV monitoring. The length of hospital ICU stay, length of hospital stay, 30-d mortality, postoperative nausea and vomiting(PONV), hypotension, tachycardia and the amount of intraoperative fluid transfusion and blood transfusion were recorded.Results A total of 1055 patients were included, with 713 patients in the GDFT group and 342 patients in the CFI group. The amount of intraoperative fluid transfusion in CFI group [(1611.26±828.40) ml] was more than GDFT group [(1497.35±730.73) ml], which was statistically significant(P<0.05). The length of ICU stay in the GDFT group was(1.93±3.77) d, the hospital stay was(30.20±17.40) d, the incidence of 30-d mortality was 4.35% and the incidence of PONV was 20.90%, while the data for the CFI group were respectively(1.95±4.12) d,(30.26±19.20) d, 5.26% and t 25.73%, and there was no statistical difference between the two groups.Conclusions Goal-directed fluid therapy with SVV monitoring has no effect on the outcome of patients undergoing abdominal surgery.