LCR、PVI与IVCrvi目标导向液体治疗对单肺通气老年全腔镜食管癌根治术患者血流动力学的影响

Effects of LCR, PVI and IVCrvi target guided fluid therapy on hemodynamics in elderly patients undergoing single-lung ventilation after total endoscopy radical resection of esophageal carcinoma

目的分析乳酸清除率(LCR)、脉搏变异指数(PVI)与下腔静脉内径呼吸变异指数(IVCrvi)液体治疗对单肺通气老年全腔镜食管癌根治术患者血流动力学的影响。方法将拟行单肺通气全腔镜食管癌根治术的106例老年食管癌患者随机均分为对照组和观察组。对照组术中给予常规液体治疗,观察组术中给予以LCR、PVI与IVCrvi为目标导向的液体治疗。比较两组术前(T0)、单肺通气前(T1)、单肺通气15 min(T2)、单肺通气1 h(T3)及单肺通气结束时(T4)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、每搏输出量变异度(SVV)和心脏指数(CI)。比较两组液体出入量及药物应用情况。同时记录术前和术后肺功能参数。结果两组各时间点HR比较差异均无统计学意义(P>0.05),观察组T2~T4时间点MAP、CI和SVV、LCR高于对照组,CVP、PVI、IVCrvi低于对照组(P<0.05)。观察组单肺通气时间、晶体液用量、总输液量、尿量、出血量及使用去氧肾上腺素占比低于对照组,胶体液用量高于对照组(P<0.05)。观察组术后第1秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC均高于对照组(P<0.05)。结论以LCR、PVI与IVCrvi为目标导向的液体治疗可稳定单肺通气老年患者全腔镜食管癌根治术患者的血流动力学。

Aim To analyze the effects of fluid therapy with lactic acid clearance(LCR),pulse variation index(PVI)and pulse perfusion variance index(IVCrvi)on hemodynamics during single-lung ventilation in elderly patients undergoing total endoscopy radical resection of senile esophageal cancer.Methods A total of 106 elderly patients with esophageal cancer undergoing total endoscopic radical resection were randomly divided into control group and observation group.The control group received conventional fluid treatment,and the observation group received target-directed fluid treatment based on LCR,PVI and IVCrvi.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),stroke output variation(SVV)and cardiac index(CI)were recorded before operation(T0),before single-lung ventilation(T1),15min after single-lung ventilation(T2),1h after single-lung ventilation(T3),and at the end of single-lung ventilation(T4).The fluid intake and drug use of the two groups were compared.At the same time,the pulmonary function parameters of the two groups were recorded before operation and after operation.Results There was no significant difference in HR between the two groups(P>0.05).MAP,CI,SVV and LCR at T2-T4 time point in the observation group were significantly higher than those in the control group,while CVP,PVI and IVCrvi in the observation group were lower than those in the control group(P<0.05).The time of single-lung ventilation,the amount of crystal solution,the total infusion volume,urine volume,bleeding volume and the proportion of using deoxyepinephrine in the observation group were lower than those in the control group,and the amount of colloidal solution was higher than those in the control group(P<0.05).The forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),FEV1/FVC in the observation group were higher than those in the control group(P<0.05).Conclusion Target-directed fluid therapy with LCR,PVI and IVCrvi can stabilize hemodynamics in elderly patients undergoing total endoscopic radical resection of esophageal cancer on single-lung ventilation.