胸腔内血容积指数在老年食管癌根治术目标导向液体治疗中的应用

Application of fluid therapy directed by intrathoracic blood volume index in aged patients undergoing radical esophagectomy

目的观察胸腔内血容积指数(ITBVI)在老年食管癌根治术目标导向液体治疗中的应用效果。方法择期行食管癌根治术老年患者18例,年龄65～82岁,ASAⅠ或Ⅱ级,胸腔内操作期间均行单肺通气。容量治疗以维持合适的ITBVI为目标,监测麻醉诱导前(T1)、诱导后(T2)、侧卧位双肺通气20min(T3)、单肺通气20min(T4)、肺复张双肺通气20min(T5)、平卧位双肺通气20min(T6)、气管导管拔除时(T7)的心指数(CI)、血管外肺水指数(EVLWI)和肺血管通透性(PVPI);监测单肺通气开始后15、30、45、60、75和90min时连续心指数(PCCI);记录单肺通气时间及尿量。结果各时点CI均在正常值范围内,但T7时高于T3～T5时(P<0.01),T6时高于T5时(P<0.01);EVLWI均高于正常参考值,T6、T7时低于T4时(P<0.01)。PVPI及PCCI均在正常范围内,各时点间差异无统计学意义。单肺通气时间为(267.2±39.3)min;术毕尿量为(500.0±157.2)ml。结论老年患者食管癌根治术中以维持正常ITBVI为目标进行液体治疗,有利于维持心输出量且不增加肺水肿风险。

Objective To observe the efficacy of the application of fluid therapy directed by intrathoracic blood volume index （ITBVI） in aged patients undergoing radical esophagectomy. Methods Eighteen patients, 65-82 years old, ASA I or lI, scheduled for radical esophageetomy, used one-lung ventilation （OLV） during the intra thoracic procedure. The fluid therapy is directed by maintaining suitable ITBVI. Cardiac index （CI）, extravascular lung water index （EVLWI） and pulmonary vascular permeability index （PVPI） were monitored before （T1） and after （T2） anesthesia induction, 20 min after total lung ventilation （TLV） in lateral position （T3）, 20 rain after OLV （T4）, 20 rain after pulmonary re-expansion （T5）, 20 min after OLV in supine position （T6）, and immediately after extubation （T7）. Pulse counter cardiac index（PCCI） were monitored at 15, 30, 45, 60, 75 and 90 min after OLV. OLV duration and urinary volume were also recorded. Results CI was in normal range at all time points. CI at T7 was higher than at T3, T4 and Ts （P〈0.01）, and was higher at T6 than at T5 （P〈 0.01）. EVLWI was over the normal value at all time points. EVLWI was lower at T6 and T7 than at T4 （P〈0. 01）, PVPI and PCCI during ,the OLV period were in normal range, and there was no statistic difference among them. Mean OLV duration was （267.2± 39.3） minutes and mean urinary volume was（500.0±157.2）ml. Conclusion ITBVI-directed fluid therapy was favorable for maintaining cardiac output without raising the risk of pulmonary edema, in aged patients undergoing radical esophagectomy.