不同导向液体治疗对乳腺癌改良根治患者术后恶心呕吐的影响

Influence of different goal-directed goal-directed fluid therapies on postoperative nausea and vomiting in breast cancer patients undergoing modified radical mastectomy.

目的观察不同导向液体治疗对乳腺癌改良根治患者术后恶心呕吐(PONV)的影响.方法全身麻醉下行乳腺癌根治术女性患者50例,年龄25~60岁,ASA分级为Ⅰ或Ⅱ级,采用随机数字表法分为中心静脉压(CVP)治疗组(对照组)和Flotrac/Vigileo指导治疗组(观察组),每组25例.对照组根据患者术中MAP、HR和CVP等进行液体治疗.观察组在Flotrac/Vigileo监护仪指导下,根据SVV和CI行液体治疗.分别于入室建立监测后(T0)、麻醉诱导后(T1)、手术开始后2 h(T2)、术毕(T3)监测平均动脉压(MAP)、心率(HR)、CVP、心输出指数(CI)、每搏变异度(SVV)的变化;并统计术中液体出入量及相应时间点乳酸(LAC).探讨两组患者术后0~2 h、2~6 h、6~12 h、12~24 h时间段恶心、呕吐发生率及比较相应时间MAP、HR.结果T1时,对照组患者MAP低于观察组,HR高于观察组(P<0.05).对照组患者术中液体总入量少于观察组(P<0.05).两组患者PONV的发生情况比较,术后0~2 h、2~6 h、6~12 h 3个时间段,观察组患者术后恶心VAS评分、呕吐的发生率均低于对照组(P<0.05);在12~24 h时间段,上述比较差异无统计学意义(P>0.05).术后0~2 h、2~6 h、6~12 h 3个时间段,观察组患者MAP高于对照组(P<0.05),术后12~24 h时间段MAP比较差异无统计学意义(P>0.05).结论Flotrac/Vigileo指导的液体治疗能实现术中更加有效的液体管理,且有利于减少术后恶心呕吐的发生.

Objective To investigate the influence of goal-directed fluid therapy on postoperative nausea and vomiting(PONV)in breast cancer patients undergoing modified radical mastectomy.Methods Fifty patients(ASAⅠ-Ⅱ),who aged 25~60 years and scheduled for elective modified radical mastectomy under general anesthesia,were ran-domly divided into conventional fluid therapy(control group)and goal-directed fuid therapy group(observation group)(n=25).Fluid therapy in control group were guided by MAP,CVP and HR,while observation group were based on stroke volume variation(SVV)and cardiac index(CI)according to the Flotrac/Vigileo.The variation of MAP,HR,CVP,CI and SVV at the onset of the monitring(TO),the moment after anesthesia induction(T1),two hours after sur-gery(T2)and the end of the surgery(T4).Fluid infusion and output,as well as the level of lactic acid were measured.The incidence of nausea and vomiting during0-2h,2-6h,6-12 h and 12-24 h,heart rate and mean arterial pres-sure were recorded at the corresponding time points for comparison.Results At T1,MAP was significantly lower in ob-servation group than that in control group,while HR was significantly higher(P<0.05).Total infused fluid volume were significantly lower in control group than those in observation group(P<0.05).The postoperative nausea VAS score and the incidence of vomiting in observation group were significantly lower than those in control group during0-2 h,2-6 h and 6-12 h after operation(P<0.05),while there were no significant difference during 12-24 h(P>0.05).The MAPs were significantly higher in observation group than those in control group during0-2 h,2-6h and 6-12 h after operation(P<0.05).Conclusion Goal-directed therapy according to Flotrac/Vigileo could effectively achieve intrao-perative liquid management and lower the incidence of PONV.