目标导向液体治疗对脊柱侧弯矫形手术患者术中局部脑氧饱和度和术后并发症的影响

Effects of goal-directed fluid therapy on intraoperative regional cerebral oxygen and postoperative complications in patients undergoing spinal scoliosis surgery

目的观察目标导向液体治疗(GDFT)对脊柱侧弯矫形手术患者术中局部脑氧饱和度(rSO_2)和术后并发症的影响。方法择期全麻下行脊柱侧弯矫形手术患者60例,男12例,女48例,年龄48～75岁,BMI 19～28 kg/m^2,ASAⅡ或Ⅲ级。采用随机数字表法分为观察组和对照组。对照组采取传统液体管理方法维持MAP>基础值的80%,CVP 8～12 mmHg,尿量>0.5 ml·kg^(-1)·h^(-1)。观察组通过桡动脉连接FloTrac/Vigileo监测系统,并在每博量变异度(SVV)指导下行GDFT,维持CI>2.5 L·min^(-1)·m^(-2)。记录麻醉诱导前(T_0)、麻醉诱导后5 min(T_1)、俯卧位时(T_2)、切皮时(T_3)、内固定时(T_4)、矫形时(T_5)、术毕(T_6)的rSO_2,并计算rSO_2平均值■、rSO_2最小值(rSO_(2min))以及rSO_2较基础值下降的最大百分比(rSO_(2%max))。记录术中晶体液和胶体液用量、总输液量、出血量、尿量及去甲肾上腺素的使用情况。记录术后住院期间肺部炎症、恶心呕吐、心律失常、发热及低血压等并发症的发生情况。结果与对照组比较,观察组术中晶体液用量、总尿量明显减少(P<0.05),胶体液用量明显增加(P<0.05),去甲肾上腺素使用量明显减少(P<0.05),术中■、rSO_(2min)明显升高(P<0.05),术后住院期间肺部炎症及恶心呕吐发生率明显降低(P<0.05)。结论目标导向液体治疗可以升高脊柱侧弯矫形手术患者术中rSO_2,减少术后住院期间肺部炎症及恶心呕吐的发生。

Objective To observe the effect of goal-directed fluid therapy(GDFT)on intraoperative regional cerebral oxygen and postoperative complications in patients undergoing spinal scoliosis surgery.Methods Sixty patients of scoliosis undergoing spinal scoliosis surgery,12 males and 48 females,aged 48-75 years,BMI 19-28 kg/m^2,falling into ASA physical statusⅡorⅢ,were randomly divided into:observation group and control group.Mean arterial pressure was maintained>80%basic,CVP 8-12 mmHg,urine output>0.5 ml·kg^-1·h^-1 in control group.The FloTrac/Vigileo system was used to monitor MAP,CO,CI and SVV continuously in observation group;GDFT was performed under the guidance of SVV,and CI was maintained>2.5 L·min^-1·m^-2.Continuous monitoring of rSO2 was performed and the rSO2,rSO2min and rSO2%max were calculated in both groups.The amount of crystalloid and colloid used,total volume of fluid infusion,bleeding volume,urine output,and the dose of norepinephrine were recorded during operation.The complications after operation such as pneumonia,PONV,arrhythmia,fever cough and hypotension were recorded.The length of hospital stay was recorded.Results Compared with the control group,the amount of crystalloid,total volume of fluid,urine output and norepinephrine were significantly decreased,the colloid was increased in the observation group(P<0.05).Compared with the control group,The rSO2 and rSO2min were increased in the observation group,while the incidence of pneumonia and PONV after operation in the hospital were lower in the observation group(P<0.05).Conclusion The study demonstrated that GDFT could improve the regional cerebral oxygen saturation during operation,and reduce the incidence of postoperative pneumonia and PONV among in patients undergoing spinal scoliosis surgery.