术中目标引导液体治疗对高危老年患者术后预后的影响

Effects of intraoperative goal-directed fluid therapy by using arterial wave analysis on outcome of high-risk elderly patients

目的：观察基于动脉压波形变化参数分析（FloTrac）的术中液体治疗对老年高危手术患者术后预后的影响。方法这是一项前瞻性、标签开放的随机对照研究。将2013年10月至2014年11月138例≥65岁在北京大学第一医院拟行腹部大手术的患者随机分为两组（每组69例）。对照组术中进行常规监测、按临床现有常规进行术中液体管理；目标引导液体治疗（GDT）组术中使用FloTrac/Vigileo系统监测动脉压波形分析参数，通过输液和血管活性药的使用维持每博量变异度（SVV）＜13%、心脏指数（CI）≥2.5L/（min·m^2）且平均动脉压（MAP）≥65mmHg。结果 GDT组术后心血管并发症发生率明显少于对照组[2.9%（2/69） vs 11.6%（8/69），P＝0.049]；GDT组术后感染并发症发生率略少于对照组，但差异无统计学意义[13.0%（9/69） vs 26.1%（18/69），P＝0.053]。术后总的并发症发生率两组间差异无统计学意义（P＞0.05）。结论基于Flotrac的GDT能减少高危老年患者术后心血管并发症的发生，并有可能减少感染并发症的发生，但对整体预后的影响尚需更大样本量的研究证实。

Objective To investigate whether the intraoperative fluid therapy based on the parameters of arterial pressure wave analysis （FloTrac） could reduce the incidence of postoperative complications in the elderly patients after major surgery. Methods This was a prospective, open-labeled, randomized controlled trial. One hundred thirty-eight patients at an age of ≥65 years who were scheduled for major abdominal surgeries in our department from October 2013 to November 2014 were randomized into 2 groups. In the control group, routine monitoring was performed and intraoperative fluid therapy was administered according to conventional practice. In the goal-directed therapy （GDT） group, hemodynamic monitoring was performed using the FloTrac/Vigileo system, and the intraoperative goals were to maintain stroke volume variation （SVV）〈13%, cardiac index （CI） ≥2.5 L/（min·m^2）, and mean arterial pressure （MAP） ≥65mmHg. Results The incidence of postoperative cardiovascular complications was significantly lower in the GDT group than in the control group[2.9%（2/69） vs 11.6%（8/69）, P=0.049]. The incidence of postoperative infectious complications was slightly lower in the GDT group than in the control group, but the difference was not statistically significant [13.0%（9/69） vs 26.1%（18/69）, P=0.053]. There was no significant difference between the 2 groups with regard to the overall incidence of postoperative complications. Conclusion For the elderly patients undergoing major abdominal surgery, intraoperative GDT based on arterial pressure wave analysis decreases the incidence of postoperative cardiovascular complications, and also tends to decrease the incidence of postoperative infectious complications after surgery. However, its effects on the outcomes of the elderly need further study on larger samples.