目标导向性液体治疗在脊麻全髋关节置换中的应用

GOAL-DIRECTED LIQUED THERAPY DURING TOTAL HIP REPLACEMENT UNDER SPINAL ANAESTHESIA

目的探讨目标导向液体治疗对脊麻下全髋关节置换术中输液量及预后的影响。方法选择40例择期行全髋关节置换术的患者,随机分为对照组C及治疗组G,治疗组患者依据Vigileo系统监测的SVV、心搏量指数(SVI)、CI将氧输送指数(DO2I)>600ml/(min·m2)作为目标进行目标导向液体治疗。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)、脊麻穿刺后即刻(T2)、手术开始即刻(T3)、手术开始后1h(T4)、术毕(T5)的MAP、HR、CI、SVV的变化,计算术中氧供指数(DO2I)。结果与C组相比G组患者在手术期间输注的总液体量明显高于C组(6 032±1 388ml vs2 635±346ml),另外G组患者手术期间血液输注量高于C组(565±332ml vs 0±0ml),G组患者的并发症发生率明显低于C组(P<0.05)。结论目标导向液体治疗能够增加脊麻下行全髋关节置换患者术中氧供需平衡,减少术后并发症的发生。

Objective To explore the prognosis and therapeutic effect of goal-directed liquid transfusion amount in the total hip replacement under spinal anesthesia.Methods Totally 40 patients underwent total hip replacement were randomly divided into control group and protocol group（GDT）.Patients in the GDT group,in addition to standard monitoring,were connected to the FloTrac sensor/Vigileo monitor haemodynamic monitoring system,and a GDT protocol was used to maximise the stroke volume and target the oxygen delivery index to〉600ml/minute/m2.Results Patients in GDT group were given a greater volume of intravenous fluids during the intraoperative period（means±standard deviation（SD）：6,032 ± 1,388 ml vs.2,635±346 ml;P〈0.0001）.The GDT patients also received more blood transfused during the intraoperative period（means± SD：565± 332 mL vs.0±0ml;P〈0.0001）.There were an increased number of complications in the CTRL group（P〈0.05）.Conclusion Goal-directed therapy can increase supplydemand balance in patients undergoing elective total hip replacement changes during regional anaesthesia and may improve patient outcomes by decreasing postoperative complications.