目标导向液体治疗对异位妊娠失血性休克手术患者微循环的影响

Effect of goal-direct therapy on perioperative microcirculation in patients with ectopic pregnancy and hemorrhagic shock

目的：探讨目标导向液体治疗对异位妊娠失血性休克手术患者围术期微循环的影响。方法 60例ASAⅡ~Ⅲ级失血性休克患者随机分为观察组行目标导向液体治疗;对照组行常规输液治疗。连续监测ECG、MAP、中心静脉压（CVP）及心输出量（CO）,记录术前30min（T1）、术中30min（T2）、术中1h（T3）、术中2h（T4）以及术后（T5）等时点的HR、CVP、MAP,以及血乳酸浓度、尿量变化。结果：两组T2~T5各时点HR值均低于T1时点,MAP、CVP值则高于T1时点（P〈0.05）。在T2~T3时点,观察组HR值低于对照组,MAP、CVP值均高于对照组（P〈0.05）。液体治疗后,G组T3、T4时点的乳酸浓度均低于对照组,T3~T5时点的尿量均高于对照组（P〈0.05）。结论：目标导向液体治疗应用于异位妊娠失血性休克手术,可迅速扩容,有效改善微循环。

Objective：To evaluate the effect of goal-direct therapy（GDT）on perioperative microcirculation in patients with ectopic pregnancy and hemorrhagic shock.Methods：Sixty adult patients suffering hemorrhagic shock with Ⅱ toⅢ of ASA score were randomly divided into two groups：the observation group（goal-direct therapy）and the control group（conventional infusion）.Dynamic electrocardiogram（ECG）,MAP,central venous pressure（CVP）and cardiac output（CO）were monitored.And heart rate（HR）,CVP,MAP and serum lactate level,urinary volume were recorded at different times of 30 min before operation（T1）,at 30min（T2）,1h（T3）and 1h（T4）after beginning of the operation and the end of the operation（T5）.Results：HR was highest while MAP and CVP were lowest at T1 in two groups（P〈0.05）.At T2 and T3,HR in the observation group was lower than that of the control group,while MAP and CVP in the observation group were higher than those of the control group（P〈0.05）.After the treatment,the serum lactate level at T3 and T4were lower and the urinary volume at T3,T4 and T5were higher in the observation group when compare with the control group（P〈0.05）.Conclusion：The stable hemodynamics and balanced microcirculation can be maintained by GDT in patients suffering hemorrhagic shock due to ectopic pregnancy.