目标导向液体治疗在胃肠道手术术后应用的临床研究

Application of goal-directed fluid therapy in the postoperative treatment of gastrointestinal surgery

目的探讨目标导向液体治疗(GDFT)对胃肠道手术术后康复的影响及临床价值。方法前瞻性入组2015年07月至2016年12月我院普外科收治的30例胃肠道手术的患者,把其列为GDFT组,在术后行目标导向液体治疗,即根据每搏变异度(SVV)及心输出指数(CI)调整液体量。另外回顾性收集2014年01月至2015年06月我院普外科收治的30例胃肠道手术患者作为对照,列为对照组。结果 GDFT组食欲评分高于对照组,GDFT组肠鸣音恢复时间、首次肛门排气时间及住院时间均少于对照组,且差异有统计学意义(P<0.05);GDFT组在术后ARDS、肺水肿、肺部感染、心功能不全并发症的发生率低于对照组,差异有统计学意义(P<0.05);两组患者休克的发生率无统计学差异(P>0.05)。结论 GDFT可促进食欲及胃肠功能的恢复、缩短住院时间及减少术后ARDS、肺水肿、肺部感染、心功能不全等并发症的发生率,从而促进患者术后康复。

Objective To investigate the effect and clinical value of goal-directed fluid therapy（ GDFT） on postoperative rehabilitation of patients with gastrointestinal operation. Methods Thirty cases of patients with gastrointestinal operation were prospectively enrolled from July 2015 to December 2016 in Department of general surgery of our hospital,regard it as GDFT group,After the operation,goal-directed fluid therapy is used,according to the stroke volume variability（ SVV）and cardiac output index（ CI） for Adjusting liquid volume. In addition,30 cases of patients with gastrointestinal operation admitted to our hospital from January 2014 to June 2015 were retrospectively included in the control group. Results In GDFT group,appetite score was higher than that in the control group. The recovery time of bowel movement,the first time of expelling flatus and hospitalization time in GDFT group were less than that in the control group,and the difference was statistically significant（ P〈0. 05）; ARDS after surgery,pulmonary edema,pulmonary infection,heart failure complication rate in GOFT group were significantly lower than the control group（ P〈0. 05）; The morbidity ratio of shock between the two groups showed no significant difference（ P〈0. 05）. Conclusion GDFT can promote appetite and gastrointestinal function recovery,shorten the hospitalization time and reduce postoperative ARDS,pulmonary edema,pulmonary infection,heart failure and other complications,so as to promote the rapid recovery after surgery.