目标导向性液体治疗对凶险性前置胎盘患者围术期容量及凝血功能的影响

Effect of goal-directed fluid therapy on the volume and coagulation function in patients with placenta previa during perioperative period

目的观察目标导向性液体治疗对凶险性前置胎盘患者围术期液体容量及凝血功能的影响。方法行择期凶险性前置胎盘剖宫产术患者80例,随机分为(n=40):常规补液组(N组),目标管理补液组(G组)。G组连接Flo Trac/Vigileo监测系统观察△SV、CI等指标指导输液。分别记录患者术中不同时期血流动力学、凝血指标及血液乳酸含量等。结果与N组比较,G组患者晶体液输注量,HR、△SV,术中去氧肾上腺素的用量,PT、APTT、TT明显减少,而尿量,术中各时间点CVP、CI、MBP及FIB值增加(P<0.05);两组患者术毕乳酸均明显高于术前,且N组明显高于G组(P<0.05)。结论应用Flo Trac/Vigileo监测系统行目标指导液体管理,可以保证血流动力学稳定,改善患者术后凝血功能,优于常规补液。

Objective To investigate the therapeutic effect of goal-directed fluid therapy on perioperative volume therapy in patients with placenta previa during perioperative period. Methods Eighty patients undergoing cesarean section were randomly divided into 2 groups （n = 40 in each group） ： the conventional therapy group （N group） and the target management of resuscitation group （G group）. Patients in G group were connected the Flo- Trae/Vigileo monitoring system to obtain the information of ASV and CI which were used to guide goal-directed fluid therapy. Hemodynamies, blood coagulation indexes and lactic acid content in different periods of operation were recorded. Results Compared with N group, colloid infusion volume, HR, ASV, the amount of phenylephrine, PT, APTT and TT were decreased, but urine volume, CVP, CI and MBP of each time point and FIB were markedly increased （P 〈 0.05, respectively）. Conclusion The application of FloTrac/Vigileo monitoring system for goal-directed fluid therapy, real-time monitor and effectively maintain hemodynamies in patients with dangerous placenta previa during perioperative period, which can improve the postoperative coagulation function and is better than the conventional rehydration capacity.