每搏量变异度指导的液体治疗对单膝关节置换术老年患者术后恶心呕吐的影响

Effects of stroke volume variation-guided fluid therapy on postoperative nausea and vomiting in elderly patients undergoing unilateral total knee arthroplasty

目的探讨每搏量变异度（SVV）指导的目标导向液体治疗对单膝关节置换术老年患者术后恶心呕吐（PONV）的影响。方法将2014年9月至2015年6月择期行单膝关节置换术的患者随机分为A、B、C 3组。3组患者输注乳酸林格氏液8 ml/（kg·h）,达到目标范围（A组SVV 4%~6%,B组SVV 7%~9%,C组SVV 10%~12%）后,输注琥珀酰明胶维持容量状况。记录术中血流动力学变化,术中及术后24 h液体出入量,观察患者术后PONV发生率及术后镇痛情况。结果本研究共纳入60例患者,每组20例。3组患者一般资料比较,差异无统计学意义（P〉0.05）。A组与C组比较,晶体液[（1 385.62±318.97）ml vs.（777.14±170.08）ml,P〈0.05]及总液量[（1 880.00±483.87）ml vs.（1 355.71±380.07）ml,P〈0.05]均增加;C组术中血压显著低于A组（P〈0.05）;A组与C组比较,术后第1天PONV发生率明显降低（5.0%vs.40.0%,P=0.026）。3组患者术后单位时间使用镇痛药剂量的差异无统计学意义。结论充足的容量治疗可以降低单膝关节置换术患者PONV的发生率。

Objective To investigate the influence of stroke volume variation（SVV）-guided fluid therapy on postoperative nausea and vomiting in elderly patients.Methods Patients undergoing unilateral total knee arthroplasty（UTKA） were randomly divided into group A（SVV4%-6%）,group B（SVV7%-9%）,group C（SVV10%-12%）.In all groups,intraoperative basal fluid replacement was achieved by continuous infusion of 8 ml/（kg· h）crystalloid solution to get the target value.The liquid management,intraoperative hemodynamics and the incidence of postoperative nausea and vomiting were recorded.Results Sixty patients were included,20 patients in each group.There were no significant differences in general characteristics among the three groups（P〈0.05）.Compared with group C,the crystal solution [（1 385.62 ±318.97）ml vs.（777.14±170.08）ml,P〈0.05] and total fluid volume [（1 880.00±483.87）ml vs.（1 355.71±380.07）ml,P〈0.05] infused during the operation were significantly higher in group A.The blood pressure of group C was significantly lower than that in group A（P〈0.05）.The incidence of nausea and vomiting in group A was significantly lower than group C（5.0% vs.20.0%,P = 0.026）.Conclusion Sufficient blood volume can reduce the occurrence of PONV in patients with UTKA.