经食道多普勒超声指导的目标导向液体治疗在老年患者胸科手术中的应用效果

Application effect of target-directed fluid therapy guided by transesophageal Doppler in thoracic surgery in elderly patients

目的探讨经食道多普勒超声(TED)指导的目标导向液体治疗(GDFT)在老年患者胸科手术中的应用效果。方法将98例行胸外科手术治疗的老年患者,随机分为观察组48例与对照组50例。观察组患者采用TED指导的GDFT治疗,对照组患者采用中心静脉压(CVP)指导的GDFT治疗。比较两组患者术中晶体输入量、胶体输入量、尿量、去甲肾上腺素使用量、不同时点[气管插管前10 min(T_(0))、摆好侧卧体位时(T_(1))、开始单肺通气时(T_(2))、结束单肺通气时(T_(3))、手术结束时(T_(4))]血流动力学指标[心率、平均动脉压(MAP)、CVP,、校正血流时间(FTc)、心脏指数、每搏输出量(SV)和二尖瓣口E峰流速],以及术后的胸腔积液量和并发症发生情况。结果观察组患者术中晶体输液量和去甲肾上腺素使用量、术后胸腔积液量及术后肺部并发症发生率均少于或低于对照组(均P<0.05),而两组术中胶体输入量和尿量,以及术后第3天急性肾损伤、心脏并发症、低血压和神经系统并发症发生率差异均无统计学意义(均P>0.05)。两组患者的心率及MAP差异均无统计学意义(均P>0.05),观察组患者在T_(4)时的CVP高于对照组(P<0.05);观察组患者术中不同时间点的FTc、心脏指数、SV和二尖瓣口E峰流速差异均无统计学意义(均P>0.05)。结论在胸科手术中采用TED指导的GDFT能避免老年患者液体超负荷,较CVP更准确且稳定地反映血流动力学变化,更有利于维持循环稳定,术后肺部并发症少,安全性高。

Objective To investigate the application effect of target-directed fluid therapy(GDFT)guided by transesophageal Doppler(TED)in thoracic surgery in elderly patients.Methods Ninety-eight elderly patients,who underwent thoracic surgery,were randomly divided into observation group(n=48)and control group(n=50).Patients in the observation group were treated with GDFT guided by TED,and patients in the control group were treated with GDFT guided by central venous pressure(CVP).The two groups were compared in terms of intraoperative crystal infusion volume,colloid infusion volume,urine volume,norepinephrine dosage,hemodynamic indices(heart rate,mean arterial pressure[MAP],CVP,corrected flow time(FTc),cardiac index,stroke volume(SV)and peak early mitral annular velocity)at different time points,10 minutes before endotracheal intubation(T_(0)),during lying in lateral position(T_(1)),at the beginning of one-lung ventilation(T_(2)),at the end of one-lung ventilation(T_(3))and at the end of operation(T_(4)),as well as postoperative pleural effusion volume and the incidence of postoperative pulmonary complications.Results The intraoperative crystal infusion volume,norepinephrine dosage,postoperative pleural effusion volume,and incidence rate of postoperative pulmonary complications in the observation group were less or lower than those in the control group(all P<0.05),whereas there was no statistically significant difference between the two groups in intraoperative colloid infusion volume,urine volume,or incidence rate of acute renal injury,cardiac complications,hypotension or neurological complications on the 3rd day after operation(all P>0.05).There was no statistically significant difference in heart rate or MAP between the two groups(all P>0.05),and the observation group exhibited a higher CVP at T_(4)than the control group(P<0.05);there was no statistically significant difference in FTc,cardiac index,SV or peak early mitral annular velocity at different time points during operation in the observation group(all P>0.05).Conclusion TED-guided GDFT can prevent elderly patients from fluid overload in thoracic surgery,reflect hemodynamic changes more accurately and stably than CVP,contribute to maintaining circulation stability preferably,and achieve fewer postoperative pulmonary complications and high safety.