不同液体处理方式对胃肠道择期手术患者麻醉诱导期血流动力学的影响

The impact of different fluid treatment regiments on hemodynamics during anesthesia induction in patients undergoing selective gastrointestinal surgery

目的观察术前不同液体处理方式对胃肠道择期手术患者麻醉诱导期血流动力学的影响。方法选择90例18～65岁ASAⅠ或Ⅱ级拟行胃肠道择期手术患者,随机均分为三组:常规禁饮组(Ⅰ组)、术前饮糖水组(Ⅱ组)、术前快速补液组(Ⅲ组)。用胸阻抗法监测麻醉诱导前(T0)、喉镜置入前(T1)及插管后1min(T2)、3min(T3)、5min(T4)、10min(T5)的HR、MAP、心输出量(CO)、体循环阻力(SVR)、胸腔液体水平(TFC)、加速度指数(ACI)的变化,同时监测BIS值。结果三组T1时HR、MAP、CO、SVR、BIS均显著低于T0时(P<0.05)。三组T2时HR、MAP、SVR显著高于T0时(P<0.05)。Ⅰ组、Ⅲ组在T0～T5时SVR显著高于Ⅱ组(P<0.05),MAP、CO、TFC显著低于Ⅱ组(P<0.05)。此外Ⅰ组和Ⅲ组麻醉诱导期MAP降幅大于30%超过30s的发生率均显著高于Ⅱ组(P<0.05)。结论术前2h口服补液能够更好地维持胃肠道择期手术患者麻醉诱导期血流动力学的稳定。

Objective To compare the effect of different fluid treatment on hemodynamics during anesthesia induction in patients undergoing selective gastrointestinal surgery. Methods Ninety ASA class I or II patients aged 18 to 65 years old were randomly divided into three groups. Patients in group I received normal preoperative fasting. Patients in group II drank water 2 hours before anesthesia and patients in group III received rapid intravenous fluid infusion before anesthesia induction. HR, MAP,CO,SVR,ACT and TFC were recorded with impedance cardiography and BIS were aiso recorded before induction（T0 ）, just before intubation（T1 ）, 1 min（T2 ）, 3 min（T0 ）, 5 min（T4 ） and 10 min（T0 ） after intubation. Results HR, MAP, CO, SVR, BIS of the three groups at T1 were lower than those at To （P〈0. 05）. HR, MAP and SVR in all groups were significantly higher that To than at To （P〈0. 05）. SVR of group II at T0-T5 was obviously lower than that of group I and III （P〈0. 05）, but MAP,CO, TFC was higher （P〈0. 05）. The incidence of adverse event defined as MAP fell more than 30% for 30 s in group II was lower than that of group I and III during anesthesia induetion; Conclusion Fluid treamlent per os 2 h before operation can provide a stable hemodynamics during anesthesia induction in patients undergoing sdeetive gastrointestinal surgery.