每搏量变异度对失血性休克患者液体复苏效果评价

Effect evaluation of Stroke volume variation to fluid resuscitation of patients with hemorrhagic shock

目的探讨每搏量变异度指标(SVV)对失血性休克患者液体复苏的效果。方法选择失血性休克插管全麻手术患者30例,根据随机双盲原则分成两组,即常规监测组与SVV组,每组各15例。常规监测组根据生命体征、尿量、血常规、中心静脉压(CVP)等监测结果来调节输液输血的剂量和速度;SVV组根据目标导向SVV的目标值(10±2)%和心排血量(CO)、外周血管阻力等监测指标来确定输液输血的剂量和速度。比较分析两组患者对于液体复苏治疗的满意度、复苏治疗前后血流动力学的变化、复苏治疗情况以及不良反应发生情况,并进行统计学分析。结果 SVV组患者对于复苏治疗的满意度为93.33%,常规监测组患者的满意度为60.00%,SVV组的满意度明显高于常规监测组,差异有统计学意义(χ~2=4.658,P<0.05)。复苏前,两组患者的各项血流动力学指标差异无统计学意义(P>0.05);复苏后,两组患者的各项血流动力学指标均有所改善,SVV组患者的改善程度更为明显,两组的差异有统计学意义(P<0.05)。SVV组患者的复苏液体量、复苏达标时间以及液体平衡量均明显少于常规监测组,差异有统计学意义(P<0.01)。SVV组患者的不良反应发生率为6.67%,明显低于常规监测组(40.00%),差异有统计学意义(χ~2=4.658,P<0.05)。结论采用SVV指标对失血性休克患者液体复苏进行指导,表现出准确有效的优点,有效避免了患者组织水肿与低灌注状态的出现,提高了患者的满意度,改善了预后。

Objective To explore the effect of stroke volume variation（SVV） to fluid resuscitation of patients with hemorrhagic shock. Methods 30 cases of general anesthesia in patients with hemorrhagic shock were selected.According to the principle of random double blind,they were divided into routine monitoring group and SVV group with 15 cases in each.Patients in routine monitoring group adjusted dosage and speed of transfusion according to the vital signs,blood routine,urine volume,central venous pressure（CVP） monitoring results.Patients in SVV group adjusted dosage and speed of transfusion according to the target oriented the target value of SVV（10 ± 2）% and CO（cardiac output）,peripheral vascular resistance index.The satisfaction of fluid resuscitation,the changes of hemodynamics before and after resuscitation,the situation of resuscitation and the incidence of adverse reactions of the two groups were compared and statistically analyzed. Results Satisfaction with resuscitation treatment of SVV group was 93.33%,routine monitoring group was 60.00%,and the SVV group was significantly higher than the routine monitoring group,the difference had statistical significance（χ^2=4.6584,P 〈 0.05）.Before resuscitation,the hemodynamie parameters of the two groups were significantly different（P 〉 0.05）.After resuscitation,the hemodynamic parameters of the two groups were improved. The improvement of SVV group was more obvious,the difference between the two groups was statistically signiflcant（P 〈 0.05）. Recovery of fluid volume, recovery time and liquid balance of SVV group were significantly less than those of routine monitoring group,and the difference had statistical signifieanee（P 〈 0.05）.The adverse reactions rate in SVV group was 6.67%,which was significantly lower than that in routine monitoring group with 40%,and the difference was statistically significant（χ^2=4.6584, P 〈 0.05）. Conclusion SVV guidelines for fluid resuscitation in patients with hemorrhagic shock demonstrates the advantages of accurate and effective.It can effectively avoid the occurrence of edema and hypoperfusion,improved patient satisfaction,and improved prognosis.