胃肠道手术中每搏量变异监测对液体管理的指导作用

Guiding role of monitoring stroke volume variation on liquid management in gastrointestinal operation

目的比较每搏量变异(SVV)和中心静脉压(CVP)监测对胃肠道手术患者术中输液管理及预后的影响。方法选择2012年3月至2012年12月行择期全麻下胃肠道手术患者80例,随机分为CVP组和SVV组,每组40例。CVP组术中监测CVP及桡动脉压,SVV组术中SVV及心输出量。记录并比较两组病人术前、术中、术后的输血、输液量、手术时间、住院时间、排气排便时间、术后进食时间等。结果 SVV组患者术中输液量明显少于CVP组(P<0.05);SVV组患者术中出血量明显少于CVP组(P<0.05);术后3天输液总量、术中尿量及患者术后排便时间差异无统计学意义(P均>0.05);SVV组术后肛门排气时间、术后进食时间、住院时间明显短于CVP组(P均<0.05)。术后并发症CVP组9例,SVV组5例,两组并发症发生率差异无统计学意义(P>0.05)。结论 SVV指导输液可以减少术中输液量,缩短住院时间,有利于手术患者的康复。

Objective To compare the effects of monitoring stroke volume variation （SVV） and central venous pressure （CVP） on liquid management in gastrointestinal operation and the influence on prognosis. Methods Eighty patients underwent schedule operation of gastrointestinal tract under general anesthesia from March 2012 to December 2012 were enrolled in present study. The patients were randomly divided into two groups （n =40 each） ： SVV group and CVP group. The CVP and radial artery pressure in operation were monitored in CVP group, while the SVV and cardiac output in operation were monitored in SVV group. The blood transfusion volume and infusion fluid volume of pre-, intra- and post-operation, operation time, hospitalization time, exhaust and defecate time, post- operative eating time were recorded and compared. Results Compared with CVP group, the infusion fluid volume and bleeding volume in operation decreased significantly in SVV group （ all P 〈 0. 05 ）. There were no significant differences in the total infusion fluid volume three days after operation, the urine volume in operation and post- operative defecate time between two groups （ all P 〉 0.05 ）. The post-operative anus exhaust time, post-operative eating time and hospitalization time in SVV group were all less than those in CVP group （ all P 〈 0.05 ）. The post- operative complications were 9 cases for CVP group ,5 cases for SVV group, and there was no significant difference in complications between two groups （ P 〉 0.05 ）. Conclusions Guiding infusion fluid by SVV can decrease infusion fluid volume in operation, shorten hospitalization time, and favor the rehabilitation of operative patients.