心脏超声评估脊柱钉棒内固定术术中液体治疗的临床效果

Clinical Effect of Fluid Therapy in Spinal Screw Fixation Evaluated by Echocardiography

目的:应用经胸心脏超声测量相关指标评估脊柱钉棒内固定术术中按"4-2-1"法则并以血压、心率指导的液体治疗方案的效果。方法:采用前瞻性研究方法,选择2016年12月至2017年3月于全麻下择期行脊柱钉棒内固定术患者50例,年龄45~65岁,ASA分级Ⅰ或Ⅱ级,心肺功能均正常。应用经胸心脏超声测量患者术前术后左室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs)、每搏量(SV)、心排量(CO)、左室射血分数(LVEF)、主动脉速度时间积分呼吸变异度(△VTI)、主动脉峰值流速呼吸变异度(△Vpeak)。记录患者年龄、性别、体重指数(BMI)、心率、血压等一般情况。结果:术后患者LVIDd、LVIDs、SV、CO、LVEF较术前差异有统计学意义(P<0.01),且术后△VTI、△Vpeak均低于评估界值,说明患者经术中液体治疗达到足够的心排量。结论:对于心肺功能正常的脊柱钉棒内固定术患者,按"4-2-1"法则并以血压、心率指导的液体治疗方案可有效提高心脏前负荷,达到足够的心排量,减少和预防并发症的发生。

Objective： To assess the clinical effect of fluid therapy based on ＂ 4-2-1＂ rule and guided by blood pressure and heart rate in patients undergoing spinal screw fixation by transthoracic echocardiography.Methods： A prospective study was conducted to select 50 patients aged 45 to 65 years old who were undergone spinal nail stick internal fixation under general anesthesia,ASA grade I or II from December 2016 to March 2017.The cardiopulmonary function was normal.Transthoracic echocardiography was adopted to measure left ventricular end diastolic diameter（LVIDd）,left ventricular end systolic diameter（LVIDs）,stroke volume（SV）,cardiac output（CO）,left ventricular ejection fraction（LVEF）,respiratory variation in aortic velocity time integral（△VTI）,and respiratory variation in aortic flow peak velocity（△Vpeak） before and after surgery.The patient’s age,gender,body mass index（BMI）,heart rate,blood pressure and other general conditions were recorded.Results： The postoperative differences in LVIDd,LVIDs,SV,CO and LVEF were statistically significant compared with those before operation（P 〈 0.01）.△VTI and △Vpeak of postoperative patients were lower than the assessment of the boundary value,indicating that the patient through the liquid treatment had achieved adequate cardiac output.Conclusion： For patients with normal cardiopulmonary function who were operated with spinal screw fixation,the fluid therapy based on the ＂ 4-2-1＂ rule and guided by blood pressure and heart rate can effectively improve the cardiac preload,achieve adequate cardiac output,and reduce or prevent the occurrence of complications.