目标导向液体管理用于老年患者开胸手术的临床研究

Clinical Research of Goal- Directed Fluid Management in Geriatric Patients undergoing Thoracic Surgery.

目的 观察以心指数（cardiac index,CI）/每搏指数（stroke volume index,SVI）/每搏量变异度（stroke volume variation,SVV）为目标导向的液体管理策略对行开胸肺叶切除术的老年患者术后转归的影响.方法 30例行择期肺叶切除术的患者,年龄≥65岁,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级,采用随机数字表法随机分为以CI/SVI/SVV为导向的S组（n=15）和常规液体管理组（routine group,R组）（n=15）,监测围术期两组指标,包括心率（heart rate,HR）、平均动脉压（mean arterial pressure,MAP）、动脉血氧饱和度（arterial oxygen saturation,SpO2）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure,PETCO2）、气道压力（airway pressure,Pmax）、脑电双频指数（bispectral index,BIS）等,评价以CI/SVI/SVV为导向的围术期液体管理策略在改善患者术后转归方面是否优于常规液体管理策略.结果 S组患者术中不同观察时间点HR、MAP、SpO2、PETCO2、Pmax、BIS与R组比较,差异无统计学意义.S组患者术后脱离呼吸机时间4±2h、术中输液量1310±310ml、术后液体输入的正平衡量516±212ml明显小于R组患者9±3h,1920土646ml,859±335ml（P ＜0.05）,术后ICU驻留时间、氧合指数等指标S组较R组呈现良好的转归趋势.两组患者的术后并发症发生率比较差异无统计学意义.结论 以CI/SVI/SVV为目标导向的老年开胸手术围术期液体管理策略较常规液体管理策略更严格限制液体的摄入量,缩短患者呼吸机支持时间,不增加心肺并发症的发生率,有助于改善老年患者的术后转归.

Objective To evaluate the influence of goal-directed fluid management strategies based on CI/SVI / SVV in geriatric patients undergoing thoracic lobectomy.Methods Thirty patients undergoing elective lobectomy,age ≥65years,ASAI-Ⅱ,were randomly assigned to the S group （CI/SVI/SVV-directed,n =15） and the R group （Routine group,n =15）.The parameters including heart rate （HR）,mean arterial pressure （MAP）,arterial oxygen saturation （SpO2）,end-tidal carbon dioxide partial pressure （PET CO2）,airway pressure （Pmax） and bispectral index （BIS） were recorded.CI/SVI/SVV-directed fluid management strategy and the traditional fluid management strategy were compared by clinical outcomes.Results There was no statistically significant difference in general informations between the two groups.No statistically significant difference in HR,MAP,SpO2,PETCO2,Pmax and BIS was found.The respirator time 4 ± 2h,fluid intake during operation 1310 ± 310ml and positive fluid balance during post-operation period 516 ±212ml were lower in the S group compared with the R group 1920 ± 646ml,859 ± 335ml （P 〈 0.05）.The stay time in ICU of S group was shorter than R group,the oxygen index of S group was higher than R group.Conclusion CI/SVI/SVV-directed geriatric perioperative fluid management strategy is more accurate and individualized than the routine fluid management.The Individual CI/SVI/SVV-directed fluid management strategy is beneficial to improve postoperative outcome of geriatric patients.