目标导向液体治疗在腹部肿瘤切除术中的应用

The Application of Goal-directed Fluid Therapy in Patients Undergoing Abdominal Tumour Resection Surgery

目的探讨以每搏量变异度(stroke volume variation,SVV)指导的目标导向液体治疗与中心静脉压(central venous pressure,CVP)指导的传统补液方法在行腹部肿瘤切除术中的应用价值。方法择期行腹部肿瘤切除术的患者67例,ASAⅠ-Ⅲ级,随机分成2组:GDFT组(G组,n=32)和传统补液组(C组,n=35)。局麻下行桡动脉穿刺及右侧颈内静脉穿刺。G组桡动脉连接Flotrac/Vigileo,以SVV、CI等指标行目标导向液体治疗;C组监测CVP、MAP,根据CVP行传统补液。记录术中晶体量、胶体量、尿量、输血量;记录入室监测后的MAP、HR、Lac等指标。结果总输液量C组高于G组,差异有统计学意义(P<0.05)。C组术中输入晶体液量高于G组,差异有统计学意义(P<0.05)。C组尿量较G组增多,差异有统计学意义(P<0.05)。术后乳酸水平C组较G组升高,差异有统计学意义(P<0.05)。两组患者胶体液、输血量、血管活性药物差异无统计学意义。两组MAP、HR差异无统计学意义(P>0.05)。结论以SVV指导的目标导向治疗在择期行腹部肿瘤切除术的患者中,能明显减少术中液体的输入,保证微循环灌注,较传统的补液方法提供更加优化的容量治疗。

Objective To evaluate the effects of arterial pressure continuous output derived from stroke volume variation(SVV)-guided fluid management in the patients undergoing resection for abdominal tumour surgery.Methods 67 patients(ASA physical statusⅠtoⅢ)undergoing elective abdominal tumour resection surgery were randomly divided into GDFT group(group G,SVV-guided fluid management,n=32)and control group(group C,CVP-guided fluid management,n=35).Implementng radial artery puncture and internal jugular vein puncture under local anesthesia.The Flotrac/Vigileo system was used to obtain stroke volume variation(SVV)and cardiac index(CI).Group C receive conventional fluid therapy based on CVP and MAP,whereas group G receive goal-directed luid therapy based on SVVand CI.The crystalloid requirements,colloid requirements,urinary output and blood transfusion were recorded.The variation of MAP、HR、Lac on the beginning of and the end of the surgery were recorded.Results Total infused fluid volume in group C was higher than that in group G,with statistically significant difference(P<0.05).The volume of crystalloid fluid in group G was significantly lower than that in group C(P<0.05).Urine volume in group C increased compared with group G,with statistically significant difference(P<0.05).Postoperative lactate level in group C was higher than that in group G,with statistically significant difference(P<0.05).No statistically significant difference was observed in the colloidal fluid input,blood transfused volume,vasoactive drug between the two groups.There was no significant difference in HR and MAP between the two groups at each time point(P>0.05).Conclusion Fluid management guided by SVV during abdominal tumour esection surgery reduce intraoperative fluid input and ensure microcirculation perfusion,providing more optimized volume-based therapy than traditional rehydration methods.