目标导向液体治疗对老年心功能不全患者股骨骨折术后恢复的影响

Effect of goal-directed fluid therapy on postoperative recovery in elderly patients with cardiac insufficiency after femoral fracture surgery

目的评价在每搏量变异度(SVV)指导下目标导向液体治疗对老年心功能不全患者股骨骨折术后恢复的影响。方法选择2016年10月-2018年7月行股骨骨折手术且术前存在心功能不全的老年患者52例,男18例,女34例,年龄>65岁,ASAⅢ-Ⅳ级,心功能Ⅲ-Ⅳ级。采用随机数字表法分为两组:SVV组和对照组,每组26例。SVV组采用SVV对患者行目标导向液体治疗,当SVV>10%时,输注琥珀酰明胶3 ml/kg,并将SVV调整在7%~10%。对照组术中持续输注复方乳酸钠8 ml·kg-1·h-1。分别于术前及术后1 h测定动脉血乳酸浓度(Lac),术前及术后2 h测定左心室射血分数(LVEF),记录术中血管活性药的使用情况及麻醉相关不良事件的发生情况。结果与对照组比较,SVV组术后1 h动脉血Lac明显降低(P<0.05),术后2 h的LVEF明显升高(P<0.05)。两组术中使用血管活性药差异无统计学意义。两组均无麻醉相关不良事件。结论对行股骨骨折手术的老年心功能不全患者,术中目标导向液体治疗有利于改善患者预后。

Objective To evaluate the effect of goal-directed fluid therapy guided by stroke volume variability(SVV) on postoperative recovery in elderly patients with cardiac insufficiency in femoral fracture surgery. Methods Fifty-two elderly patients undergoing femoral fractures surgery from October 2016 to July 2018, 18 males and 34 females, aged >65 years, falling into ASA physical status Ⅲ-Ⅳ and NYHA cardiac function grade Ⅲ-Ⅳ were divided into two groups by random number table: SVV group and control group, 26 cases in each group. The SVV group used the Vigileo/FloTrac system to detect the patient′s SVV, and the patient underwent goal-directed fluid therapy. When SVV >10%, the patient was infused with 3 ml/kg of succinylated gelatin. And the patient′s SVV was adjusted to 7%-10%. The control group received the conventional rehydration method. The arterial blood lactate value at preoperation and postoperative 1 h, left ventricular ejection fraction at preoperation and postoperative 2 h, intraoperative vasoactive drug use and postoperative adverse reactions were observed. Results Compared with the control group, the postoperative arterial blood lactate value was significantly decreased(P < 0.05), the left ventricular ejection fraction 2 hours after surgery was increased in the SVV group(P < 0.05). A fewer patients were using vasoactive drugs during surgery in the SVV group. No significant adverse reactions were observed in the two groups after surgery. Conclusion For senile patients with cardiac insufficiency undergoing femoral fracture surgery, intraoperative SVV-guided goal-directed fluid therapy is beneficial to stabilize circulation, improve cardiac function and prognosis.