目标导向液体治疗在老年患者胃肠道手术中的应用

The application of goal-directed fluid therapy in elderly patients undergoing gastrointestinal surgery

目的探讨目标导向液体治疗在老年患者胃肠道手术中的应用。方法择期行胃肠道手术的老年患者60例，ASAⅡ或Ⅲ级，男34例，女26例，年龄75-86岁，随机分为目标导向治疗组（G组）和经典输液治疗组（C组）。局麻下行桡动脉穿刺及颈内静脉穿刺，监测BP、CVP。桡动脉连接Flotrac／Vigileo监测系统监测每搏变异度（SVV）、CI等指标。G组根据SVV、MAP、CI、心搏量指数（SVI）将CI≥2．5L·min^-1·m^-2作为目标行目标导向液体治疗，C组根据CVP及MAP行经典补液治疗。记录手术时间、晶体液量、胶体液量、尿量及出血量。记录入室建立监测后（T1）、诱导后即刻（T2）、手术开始即刻（T3）、手术开始后1h（T4）、术毕（T5）的MAP、HR、CVP、CI、SVV的变化。检测T3、T5时的SaO2、ScvO2及血乳酸含量并计算术中氧供指数（DO2I）、氧耗指数（VO2I）、氧摄取率（ERO2）。结果与C组比较，G组胶体液输注量和尿量明显增加（P〈0．05）。T3、T4时G组CI明显升高（P〈0．05），T2、T3时SVV明显降低（P〈0．05）。与C组比较，T5时G组ScvO2、DO2I、VO2I、ERO2均明显增加（P〈0．05），血乳酸浓度明显降低（P〈0．05）。结论目标导向液体治疗能有效优化胃肠道手术中老年患者的心脏前负荷，提高心输出量，保证微循环灌注，维持机体氧供需平衡，提供比经典液体治疗方案更好的容量治疗。

Objective To evaluate the application of goal-directed fluid therapy in elderly patients undergoing gastrointestinal surgery. Metlmds Sixty patients （34 male,26 female, ASA Ⅱ or Ⅲ, 75-86 years old） undergoing gastrointestinal surgery were included and randomly divided into two groups base on treatment, goal-directed fluid therapy（group G） and conventional fluid therapy （group C）. Implementing radial artery puncture and internal jugular vein puncture under local anesthesia in order to monitor blood pressure（BP） and central venous pressure（CVP）. The Flotrac/Vigileo system was used to obtain stroke volume variation （SVV） and cardiac index （CI）. As mentioned above, group C receive conventional fluid therapy based on CVP and MAP, whereas group G receive goal-directed fluid therapy based on SVV,MAP, SVI and CI with the goal of CI no less than 2. 5 L·min^-1 · m^-2. The duration of surgery, crystalloid requirements, colloid requirements, urinary output and bleeding volume were recorded. The variation of MAP,HR,CVP, CI and SVV at the onset of the monitoring（T1 ）;the moment after anesthesia induction （T2） ,the beginning of surgery（T3 ）, one hour after surgery（T4 ） and the end of the surgery（T5 ） were recorded. SaO2, ScvO2 and lactic acid content were examined at T3 and T5. The index of oxygen delivery （DO2I）, index of oxygen consumption （VO2I） and oxygen extraction ratio （ERO2） were calculated. Results The colloid volume and urinary output in group G was higher than that in group C（P〈0.05）. CI at Ta and T4 in group G was higher than that in group C（P〈0. 05）, while SVV at T2 and T3 in group G was lower than that in group C（P〈0.05）. ScvO2, DO2 I, VO2 I, ERO2 at T5 in group G were higher than that in group C（P〈0. 05）. The concentration of lactic acid at T5 in group G was lower than that in group C （P〈0. 05）. Conclusion Coal-directed fluid therapy optimizes the cardiac preload effectively in elder patients undergoing gastrointestinal surgery, improves cardiac output, guarantees the perfusion of microcirculation as well as maintain the oxygen delivery-consumption balance The treatment method is more effective than conventional fluid therapy.