限制性与非限制性补液对腹部手术病人血流动力学及组织氧代谢影响研究

The effect of restrictive and non- restrictive fluid therapy on the postoperative hemodynamics and tissue oxygenation in major abdominal surgery

目的探讨限制性与非限制性补液对腹部手术病人血流动力学及组织氧代谢的影响。方法回顾性分析2011年4月至2014年2月中山大学附属第一医院外科重症监护中心连续收治的137例外科腹部手术病人的临床资料,根据病人术中实际补液和标准补液的差异率情况分为限制补液组(差异率<-10%,95例)及非限制补液组(差异率≥-10%,42例),评估麻醉术中液体治疗对病人术后血流动力学及组织氧代谢的影响。结果限制补液组中71例(74.7%)病人每搏量变异度(SVV)>10%,非限制补液组中18例(42.8%)病人SVV>10%,差异有统计学意义(P<0.05)。非限制补液组病人术后平均动脉压[(96.9±14.0)mm Hg vs.(82.3±14.8)mm Hg,P=0.003]、收缩压[(139.0±16.3)mm Hg vs.(118.8±24.2)mm Hg,P=0.007]、舒张压[(74.1±12.4)mm Hg vs.(63.7±12.6)mm Hg,P=0.014]、心排指数[3.8±1.3 vs.3.1±0.9,P=0.035]、每搏指数[51.8±19.3 vs.41.3±14.3,P=0.047]、术后碱剩余[BEecf:(-1.8±4.2)mmol/L vs.(1.3±4.1)mmol/L,P=0.024;BEb:(-1.4±3.9)mmol/L vs(1.4±3.6)mmol/L,P=0.028]高于非限制补液组,差异有统计学意义。其余指标(心率、中心静脉压、心输出量、每搏量、中心静脉血氧饱和度、乳酸、血红蛋白、动静脉二氧化碳分压差)差异均无统计学意义(P>0.05)。结论对于腹部手术的病人,非限制补液病人术后血流动力学指标更稳定,而术中限制补液导致术后低血容量、组织低灌注及细胞缺血缺氧的发生风险增高。

Objective To discuss the effect of restrictive and non-restrictive fluid therapy on the postoperative hemodynamics and tissue oxygenation in major abdominal surgery. Methods The postoperative patient who received major abdominal surgery and admitted to surgical intensive care unit of the First Affiliated Hospital of Sun Yat-Sen University from April 2011 to February 2014 were analyzed retrospectively. The patient was divided into restrictive infusion group （〈-10%, 95 cases）and non-restrictive infusion group （≥- 10%, 42 cases） comparing with standard fluid therapy according to that textbook opinion. The effect of restrictive and non-restrictive fluid therapy on the postoperative hemodynamics and tissue oxygenation was investigated. Results There were 71 patients （74.7%） with SVV〉10% in the restrictive group and 18 patients（42.8%） in the non-restrictive group, the hypovolemic incidence in the restrictive group was significantly higher than the non-restrictive group （P〈0.05）. The mean arterial pressure [（96.9± 14.0）mmHg vs. （82.3± 14.8）mmHg, P=0.003 ], systolic blood pressure [ （139.0± 16.3） mmHg vs. （118.8±24.2） mmHg, P=0.007 ], diastolic blood pressure [（74.1 ± 12.4） mmHg vs. （63.7± 12.6） mmHg, P=0.014], cardiac index [3.8± 1.3 vs. 3.1 ±0.9, P=0.035] and stroke volume index [51.8±19.3 vs. 41.3±14.3,P=0.047] ,base exeess[BEecf： （-1.8±4.2）mmol/L vs. （1.3±4.1）mmol/L, P=0.024; BEb： （-1.4±3.9） mmol/L vs （1.4± 3.6） mmol/L, P=0.028] was significantly higher in the non-restrictive group than in the restrictive statistically group, the difference was significant （P〈0.05）. The otherindicators were not statistically significant. Conclusion For the major abdominal surgery patients, it was more prone to postoperative hypovolemia, tissue hypoperfusion and tissue hypoxia with restrictive infusion during the operation, while the hymodynamics was more stable for the patients in the non-restrictive group.