经皮肾镜术中四种不同灌注液量对容量变异指数的影响

Effects of four different perfusate volumes on pleth variability index during percutaneous nephroscopy

目的探讨经皮肾镜术中四种不同灌注液量对容量变异指数(PVI)的影响,为患者的临床监护提供指导。方法选取2018年1月至2020年2月台山市第二人民医院收治的80例肾结石患者作为研究对象,所有患者均行经皮肾镜取石术。按照随机数表法分为A、B、C、D四组,每组各20例,于从手术起开始至结束分别予以20000 mL以上、15000~20000 mL、10000~15000 mL、10000 mL以下的灌注液灌注保持术野清晰。记录比较四组患者的平均动脉压(MAP)、心率(HR)、脉搏灌注指数(PI)、脉搏容量变异指数(PVI),术中出血量、输液量、灌注时间及住院时间。结果灌注前与灌注后,四组患者的MAP、HR、PI比较差异均无统计学意义(P>0.05);灌注后PVI比较,A组[(13.31±5.24)%]、B组[(14.43±4.48)%]、C组[(15.83±4.57)%]明显低于灌注前[(18.79±4.67)%],并且灌注后A组PVI显著低于D组[(17.76±4.16)%],差异有统计学意义(P<0.05);D组、C组及B组患者的出血量明显少于A组,差异均有统计学意义(P<0.05);A组、B组、C组患者的输液量明显多于D组,差异均有统计学意义(P<0.05);A组、B组、C组及D组患者的灌注时间依次逐渐减少,差异具有统计学意义(P<0.05);A组及B组患者的住院时间明显长于D组,并且B组住院时间也明显长于C组,差异均具有统计学意义(P<0.05)。结论灌注液量越高,PVI的改变越能较早反映出经皮肾镜术中循环灌注的改变,具有重要的监测指导意义。

Objective To explore the effects of four different volumes of perfusate on pleth variability index(PVI)during percutaneous nephroscopy,and to provide guidance for the clinical monitor of patients.Methods Eighty patients with kidney stones who admitted in the Second People's Hospital of Taishan City from January 2018 to February 2020 were selected for study.All patients underwent percutaneous nephrolithotomy.According to the random number table method,they were divided into four groups:group A,group B,group C,and group D,with 20 patients in each group.From the beginning to the end of the operation,the perfusate of more than 20000 mL,15000-20000 mL,10000-15000 mL,and less than 10000 mL were perfused to keep the surgical field clear.The average arterial pressure(MAP),heart rate(HR),pulse perfusion index(PI),pleth variability index(PVI),intraoperative blood loss,infusion volume,perfusion time,and length of hospital stay were recorded and analyzed among the four groups.Results There was no significant difference in MAP,HR and PI among the four groups before and after infusion(P>0.05).The PVI after perfusion in group A(13.31±5.24)%,group B(14.43±4.48)%,group C(15.83±4.57)%were significantly lower than before perfusion(18.79±4.67)%,and the PVI of group A after perfusion was significantly lower than that in group D(17.76±4.16)%,with statistically significant differences(P<0.05).The bleeding volume of group D,group C and group B was significantly less than that of group A,and the difference was statistically significant(P<0.05).The infusion volume of group A,group B and group C was significantly more than that of group D,and the difference was statistically significant(P<0.05).The perfusion time gradually decreased from group A,group B,group C and group D,and the difference was statistically significant(P<0.05).The length of hospital stay of group A and group B were significantly longer than that of group D,and the length of hospital stay of group B were also significantly higher than that of group C(P<0.05).Conclusion With the increase of the perfusate volume,the change of PVI can reflect the change of circulatory perfusion in percutaneous nephroscopy early,which has important monitoring and guiding significance.