PiCCO技术对老年骨折患者全身麻醉手术中血流动力学评估的作用

Application of PiCCO in the evaluation of hemodynamics in elderly patients with fracture undergoing surgery with general anesthesia

目的分析脉搏指示连续心排量监测(pulse-indicated continuous cardiac output,Pi CCO)技术在老年骨折患者全身麻醉手术中进行血流动力学监测的价值。方法选取接受手术治疗的老年骨折患者60例,根据随机数字表法分为对照组与观察组,各30例。所有患者均在全麻下接受半髋关节置换术或全髋关节置换术,对照组患者术中采用常规血流动力学监护仪监测,观察组使用Pi CCO监测,对比2组患者麻醉诱导前(T0)、切皮前(T1)、打开关节囊时(T2)、关闭关节囊时(T3)血流动力学变化情况。结果2组患者手术均成功,无死亡病例。在T1—T3时点,组间心率(HR)比较差异有统计学意义(P<0.05);T2—T3时点,组间中心静脉压(CVP)、每搏变异度(SVV)比较差异有统计学意义(P<0.05);T3时点,组间平均动脉压(MAP)比较差异有统计学意义(P<0.05)。与T0时点比较,观察组T1时点心指数(CI)、肺血管通透性指数(PVPI)、血管外肺水指数(ELWI)、胸腔内血容量指数(ITBI)均降低,在T2时点升高,并在T3时点基本恢复正常,除ITBI外,其他指标水平组内各时点比较,差异无统计学意义(P>0.05)。观察组术中补液量及尿量均少于对照组,首次排气时间、排便时间、正常饮食时间均短于对照组,差异有统计学意义(P<0.05)。结论老年骨折患者全身麻醉术中使用Pi CCO技术监测,能够准确监测并反映患者血流动力学状态,指导术中合理进行液体管理,提高麻醉质量,对增强手术效果、加速患者术后胃肠道功能的恢复有积极意义。

Objective To analyze the use of pulse-indicated continuous cardiac output(Pi CCO)in monitoring the hemodynamics of elderly patients with fracture undergoing surgery with general anesthesia.Methods A total of 60 elderly patients with fracture who underwent surgery were selected.According to the random number table method,they were divided into two groups(n=30):a control group and an observation group.All the patients underwent hemi-arthroplasty or total hip arthroplasty.Patients in the control group were monitored by a conventional hemodynamic detector,while those in the observation group received Pi CCO monitoring.Both groups were compared for their hemodynamic changes before anesthesia induction(T0),before skin incision(T1),when the joint capsule was opened(T2)and closed(T3).Results There was statistical difference in heart rate(HR)between the two groups at T1 to T3(P<0.05);in central venous pressure(CVP)and stroke volume variation(SVV)between the two groups at T2 and T3(P<0.05);and in mean arterial pressure(MAP)between the two groups at T3(P<0.05).Compared with those at T0,the observation group showed decreases in cardiac index(CI),pulmonary vascular permeability index(PVPI),extravascular lung water index(ELWI),and intrathoracic blood volume index(ITBI)at T1;these indicators increased at T2 and basically returned to normal at T3;no statistical difference was found in each time points in all the indicators except ITBI within the group except(P>0.05).Furthermore,the observation group presented remarkably decreased intraoperative fluid infusion volume and urine volume,as well as shortened first exhaust time,defecation time and normal eating time,compared with the control group(P<0.05).Conclusions The use of Pi CCO in monitoring elderly patients with fracture who undergo surgery with general anesthesia can accurately reflect the hemodynamics of patients,guide rational fluid management during surgery,improve the quality of anesthesia,and enhance the surgical effects,and play a positive role in accelerating the recovery of gastrointestinal function after surgery.