基于每博量变异的目标导向液体治疗对脑膜瘤切除术血流动力学和S100β蛋白的影响

Goal⁃directed fluid therapy on hemodynamics and S100βprotein in meningioma resection

目的对脑膜瘤切除术患者围术期采用Vigileo系统监测每博量变异(stroke volume varia⁃tion,SVV)进行目标导向液体治疗,探讨其对此类手术血流动力学和S100β蛋白的影响。方法择期行仰卧位脑膜瘤切除术患者48例,随机分成2组:目标导向液体治疗组(G组)和常规输液组(C组)。G组采用Vigileo系统以SVV<13%为目标指导补液。两组均以维持正常的平均动脉压(MAP)、红细胞压积(Hct)与血红蛋白(Hb)为基础实施液体治疗。观测不同时点两组患者的血流动力学指标、S100β蛋白及预后的影响。结果与C组相比,G组患者尿量和胶体量增加,晶体量和总出入量减少,术毕MAP和CI增加,S100β蛋白水平降低,术后监护病房停留时间和住院时间缩短,术后1、3 d MMSE评分增加(P<0.05)。结论脑膜瘤切除术采用FloTrac/Vigileo监测SVV实施目标导向液体治疗,能维持有效循环血容量,保证组织灌注,降低术后神经损伤标志物S100β蛋白水平,减轻认知功能损害,有利于患者预后。

Objective The research aimed to investigate the effects of goal⁃directed fluid therapy on hemo⁃dynamics and S100βprotein in patients undergoing meningioma resection.Methods Forty⁃eight patients undergo⁃ing meningioma resection with supine position were randomly divided into 2 groups:routine fluid therapy group(group C)and GDFT group(group G).The strategy in group G is to maintain stroke volume variation(SVV)<13%.Fluid therapy was based on the normal artery pressure,hemoglobin and hematocrit.The hemodynamic indexes were recorded at all time intervals.S100βprotein and rehabilitation indicators in two groups perioperative.Results Compared with group C,the urine volume,amount of colloids,MAP and CI were significantly increased⁃while the amount of crystals,the total fluid intake and output,the concentration of S100βprotein,the length of stay in the ICU and hospital were significantly decreased in group G(P<0.05).Conclusion During meningioma resection,GDFT guided with SVV not only maintain the effective circulating blood volume and systemic perfusion but also decrease the concentration S100βprotein,improve clinical outcomes.