不同每搏变异度指导下的目标导向液体治疗对肝癌手术患者术后肝肾功能的影响

Effects of stroke volume variation guided goal-directed fuid therapy on liver and renal function of patients after liver cancer surgery

目的 :探讨不同每搏量变异度(stroke volume variation, SVV)指导的目标导向液体治疗(goal-directed fuid therapy, GDFT)对肝癌手术患者术后肝肾功能的影响。方法:选取60例中国医学科学院北京协和医学院肿瘤医院行择期肝脏手术的肝癌患者,随机分为低SVV组(1 5,高SVV组> 9),则在15min内给予250ml羟乙基淀粉快速输注,观察SVV变化;若SVV仍高于分组阈值,重复给予,直至SVV回落至分组阈值内。记录术中出入量、手术时间、术后3d内谷草转氨酶、谷丙转氨酶、活化部分凝血活酶时间、血肌酐、血尿素氮等肝肾功能指标。结果:术中胶体用量低SVV组显著高于高SVV组[900(425)ml比500(525)ml,P <0.05],术中液体总入量低SVV组显著高于高SVV组[(2340.0±856.5)ml比(1885.0±730.4)ml,P <0.05],出血量、尿量两组患者间无显著性差异,两组患者血清AST、ALT、APTT水平,以及Cr、BUN水平,在术后1d、术后2d、术后3d差异无统计学意义。结论:基于SVV指导的目标导向液体治疗,将有利于术中限制液体输入量,且对术后肝肾功能无影响,利于肝癌术中液体管理。

Objective: To investigate the effect of stroke volume variation(SVV) guided goal-directed fuid therapy(GDFT) on liver and renal function of patients after liver cancer surgeries. Methods: Sixty patients undergoing liver cancer surgeries in cancer hospital of Chinese academy of medical sciences were randomly divided into a low SVV group(1 < SVV ≤ 5) and a high SVV group(5 < SVV ≤ 9). In both groups, doses of ringer lactate were infused slowly at a steady speed. If SVV was higher than the threshold(SVV>5 in the low SVV group and SVV>9 in the high SVV group), a dose of 250 ml hydroxyethyl starch 130/0.4 was given within 15 minutes to observe the changes of SVV. If SVV is still higher than the threshold, such dose was repeatedly given until SVV readings fall below the threshold. Records of fuid intake and output during operation, as well as operation time are done and kept, besides AST, ALT, APTT, Cr, BUN and other liver and renal function indicators within 3 days post-surgery. Results: The amount of fluid input was significantly reduced in the high SVV group, and there was no statistical difference in postoperative liver and kidney function compared with the low SVV group. Conclusion: Goal-directed fuid therapy based on SVV guidance will facilitate intraoperative fuid input limitation and intraoperative fuid management in liver cancer surgery.