目标导向液体治疗对妇科腹腔镜手术术中血流动力学及脑氧饱和度的影响

Effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation in gynecologic laparoscopic surgery

目的观察目标导向液体治疗(GDFT)对妇科腹腔镜手术术中患者血流动力学及脑氧饱和度(rSO2)的影响。方法选择择期全麻下行腹腔镜妇科肿瘤根治手术患者42例,年龄45~65岁,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:传统液体治疗组(C组)和GDFT组(G组),每组21例。通过LiDCOrapid监测系统监测MAP、心输出量(CO)、心脏指数(CI)、每搏量变异度(SVV)。C组采用传统液体疗法;G组采用SVV指导下的GDFT,维持CI≥2.5 L·min^-1·m^-2。记录麻醉诱导前(T0)、麻醉诱导后(T1)、Trendelenburg体位后30 min(T2)、Trendelenburg体位后1 h(T3)及术毕(T4)时的HR、MAP、CO、CI、SVV、rSO2;记录术中总输液量、晶体液用量、胶体液用量、尿量、血管活性药物使用情况;检测患者术后2 h凝血功能及术后3个月肝肾功能。结果与C组比较,T3时G组HR明显加快(P<0.05),CI明显升高(P<0.05),T2、T3时G组CO明显升高(P<0.05),T1-T3时G组SVV明显降低(P<0.05);G组术中晶体用量[(1 519±472)ml vs(2 112±433)ml]和总输液量[(2 526±587)ml vs (2 745±582)ml]明显减少(P<0.05),胶体用量[(1 007±196)ml vs (633±189)ml]明显增加(P<0.05)。两组患者围术期rSO2、术中尿量、血管活性药物使用、术后2 h凝血功能、术后3个月肝肾功能差异无统计学意义。结论在SVV指导下的GDFT可减少术中总输液量,同时可稳定Trendelenburg体位下行腹腔镜妇科手术患者的血流动力学,且不影响rSO2。

Objective To evaluate the effect of goal-directed fluid therapy(GDFT) on hemodynamic and regional cerebral oxygen saturation(rSO2) in Trendelenburg position in gynecologic laparoscopic surgery. Methods Forty-two patients scheduled for gynecological cancer cure, aged 45-65 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups(n = 21)using a random number table: conventional fluid therapy group(group C) and GDFT group(group G). The LiDCOrapid system was used to monitor cardiac output(CO), stroke volume variation(SVV) and cardiac index(CI) in both groups. Patients in group C received routine fluid replacement based on MAP and urine volume. Patients in group G were treated under goal-directed fluid infusion strategy with a target of SVV ≤13% and CI ≥2.5 L·min^-1·m^-2. Intraoperative continuous monitoring of rSO2 was performed in both groups. MAP, HR, CO, CI, SVV, rSO2 before anesthesia induction(T0), after induction(T1), in Trendelenburg position for 30 min(T2), 1 h(T3) and the end of surgery(T4) were recorded. The requirement for crystalloid and colloid, total volume of fluid infused, urine volume, and requirement for vasoactive agents were recorded during operation. Blood coagulation function was measured 2 hours after operation. Liver and kidney function were detected 3 months later. Results Compared with group C, HR, CI at T3, and CO at T2,T3 were increased significantly in group G(P < 0.05),while SVV at T1-T3 in group G were decreased(P < 0.05). Compared with group C, the requirement for crystalloid [(1 519 ± 472)ml vs(2 112 ± 433) ml] and total volume [(2 526 ± 587) ml vs(2 745 ± 582) ml] were significantly decreased(P < 0.05),the requirement for colloid was increased significandy [(1 007 ± 196) ml vs(633 ± 189)ml](P < 0.05).There was no significant difference between the two groups in terms of rSO2, blood coagulation 2 hours after operation and liver and kidney function 3 months after operation. Conclusion The GDFT based on SVV stabilizes the hemodynamic effectively while reducing the total intraoperative infusion volume in Trendelenburg position in gynecologic laparoscopic surgery.