目标导向液体治疗在老年患者胃肠肿瘤手术中的应用

The application of goal-directed fluid therapy in elderly patients undergoing resection of gastrointestinal tumor

目的探讨目标导向液体治疗在老年患者胃肠道肿瘤手术中的应用。方法择期行胃肠肿瘤手术的老年患者60例,年龄65~82岁,ASAⅡ或Ⅲ级,采用随机数字表法分为两组(n=30):目标导向治疗组(G组)和常规液体治疗组(C组)。术中连续监测HR、MAP、CVP、SpO_2和PETCO_2。同时连接Flotrac/Vigileo监测系统监测每搏变异度(SVV)、心输出量(CI)等指标。根据SVV、MAP、CI、心搏量指数(SVI)将CI≥2.5 L·min^(-1)·m^(-2)作为目标行目标导向液体治疗,C组根据CVP及MAP行常规补液治疗。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(T0)、诱导后即刻(T1)、手术开始即刻(T2)、手术开始后1 h(T3)、术毕(T4)的MAP、HR、CVP、CI、SVV的变化。检测T2、T4时的Sa O2、Scv O2及血乳酸含量并计算术中氧供指数(DO2I)、氧耗指数(VO2I)、氧摄取率(ERO2)。结果与C组比较,G组液体输注量明显减少(P<0.05),但尿量变化不大。T2、T3时G组CI明显升高(P<0.05),T1、T2时SVV明显降低(P<0.05)。与C组比较,T4时G组Scv O2、DO2I、VO2I、ERO2均明显增加(P<0.05),血乳酸浓度明显降低(P<0.05)。结论目标导向液体治疗能优化胃肠肿瘤手术中老年患者的输液方案,减轻心脏前负荷,提高心输出量,保证微循环灌注,维持机体氧供需平衡,提供比常规液体治疗方案更好的容量治疗。

Objective To evaluate the application of goal-directed fluid therapy in elderly patients undergoing resection of gastrointestinal tumor.Methods SSixty patients（ASA Ⅱor Ⅲ,65~82 years old）undergoing resection of gastrointestinal tumor were included and randomly divided into two groups based on treatment（n=30）：goal-directed fluid therapy（group G）and conventional fluid therapy（group C）.HR,mean arterial pressure,central venous pressure,arterial oxygen saturation and partial pressure of end-tidal CO_2 were monitored continuously in two groups.Radial artery puncture and internal jugular vein puncture under local anesthesia were implemented in order to monitor blood pressure（BP）and central venous pressure（CVP）.The Flotrac/Vigileo system was used to obtain stroke volume variation（SVV）and cardiac index（CI）.As mentioned above,group C receive conventional fluid therapy based on CVP and MAP,whereas group G receive goal-directed fluid therapy based on SVV,MAP,SVI and CI with the goal of CI no less than 2.5 L·min^（-1）·m^（-2）.The duration of surgery,crystalloid requirements,colloid requirements,urinary output and bleeding volume were recorded.The variation of MAP,HR,CVP,CI and SVV at the onset of the monitoring（T0）,the moment aftter anesthesia induction（T1）,the beginning of surgery（T2）,one hour after surgery（T3）and the end of the surgery（T4）were recorded.SaO_2、ScvO_2 and lactic acid content were examined at T2 and T4.The index of oxygen delivery（DO_2I）,index of oxygen consumption（VO2I）and oxygen extraction ratio（ERO2）were calculated.Results The fluid volume in group G was less than that in group C（P〈0.05）.CI at T2 and T3 in group G was higher than that in group C（P〈0.05）,while SVV at T1 and T2 in group G was lower than that in group C（P〈0.05）.ScvO_2、DO_2I、VO_2I、ERO_2at T4 in group G were higher than that in group C（P〈0.05）.The concentration of lactic acid at T4 in group G was lower than that in group C（P〈0.05）.Conclusion Goal-directed fluid therapy optimizes the cardiac preload effectively in elder patients undergoing gastrointestinal surgery,improves cardiac output,guarantees the perfusion of microcirculation as well as maintain the oxygen delivery-consumption balance.The treatment method is more effective than conventional fluid therapy.