目标导向液体治疗对妊娠合并心功能不全患者的围手术期临床疗效分析

Analysis of the clinical effect of goal-directed volume therapy on the perioperative of pregnancy with cardiac insufficiency

目的在Flortrac/Vigileo系统监测下的目标导向液体治疗对妊娠合并心功能不全患者围手术期的指导作用。方法选择驻马店市中心医院2012年1月至2019年12月择期腰硬联合麻醉下行剖宫产术的63例合并心功能不全的高危妊娠患者,根据是否应用Flortrac/Vigileo系统监测下的目标导向液体治疗,随机分为对照组(常规输液组,n=28例)和观察组(目标导向液体治疗组,n=35例)。比较两组患者患者手术前后N末端B-型利钠肽前体(NT-proBNP)变化及围手术期患者心力衰竭、低血压等心血管严重并发症发生情况。结果与观察组相比,对照组术中晶体、胶体、液体输注总量显著升高,术后NT-proBNP升高值△NT-proBNP更加显著,差异有统计学意义(P <0.05)。围手术期,对照组心功能恶化及死亡等并发症发生率均较观察组高,差异均有统计学意义(P <0.05)。结论目标导向液体治疗,能减少妊娠合并心功能不全患者围手术期并发症,改善预后。

Objective To evaluate the effect of goal-directed volume therapy on the perioperative of pregnancy with cardiac insufficiency under Flortrac/Vigileo monitoring system. Methods From January 2012 to December 2019, 63 high-risk pregnant women with cardiac insufficiency undergoing cesarean section under combined spinal and epidural anesthesia were randomly divided into control group(n = 28 cases)and observation group(n = 35 cases)according to the application of target directed liquid therapy monitored by Flortrac/Vigileo system. The changes of NT-pro BNP before and after operation, the occurrence of cardiovascular complications such as heart failure and hypotension were analyzed. Results Compared with observation group, The crystal and colloid and liquid infusion volume were significantly increased and the difference of NT-pro BNP(△NT-pro BNP)was significantly higher in control group(P < 0.05). During the perioperative period, the incidence of complications such as cardiac function deterioration and death in the control group was higher than that in the observation group(P < 0.05). Conclusion Goal-directed volume therapy can reduce the perioperative complications and improve the prognosis of pregnancy patients with cardiac insufficiency.