SVV目标导向液体治疗对腰椎手术老年患者内脏灌注的影响:采用胃黏膜内pH值评价

Effect of goal-directed fluid therapy based on stroke volume variation guidance on splanchnic perfusion in elderly patients undergoing lumbar spine surgery:evaluation using gastric mucosal pH value

目的采用胃黏膜内pH(pHi)值评价每搏量变异度(SVV)目标导向液体治疗对腰椎手术老年患者内脏灌注的影响。方法择期全麻下行腰椎手术老年患者160例,性别不限,年龄65~80岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=80):SVV目标导向液体治疗组(G组)和传统液体治疗组(C组)。G组以SVV<15%作为目标行目标导向液体治疗,C组以MAP、CVP和尿量为指导行常规输液。记录2组患者术中晶体液用量、胶体液用量、总输液量、出血量、尿量、血管活性药物的使用情况及围术期输血情况;记录2组患者麻醉诱导前(T_(1))、手术开始后1 h(T_(2))及术毕(T_(3))时CI、SVV、pHi值、胃黏膜CO_(2)分压(PgCO_(2))、PaCO_(2)和动脉血气分析结果;记录2组患者术后并发症发生情况、排气时间、排便时间和住院时间。结果与C组相比,G组患者术中晶体液用量、总输液量、尿量及血管活性药物使用率降低,胶体液用量升高,T_(2),3时CI和pHi值升高,SVV、Pg-aCO_(2)和动脉血Lac浓度降低(P<0.05),术中出血量、动脉血pH值、PaCO_(2)、BE、患者术后并发症发生率、排气时间、排便时间和住院时间比较差异无统计学意义(P>0.05)。结论SVV目标导向液体治疗改善腰椎手术老年患者内脏灌注的作用优于传统液体治疗。

Objective To evaluate the effect of goal-directed fluid therapy(GDFT)based on stroke volume variation(SVV)guidance on splanchnic perfusion using gastric mucosal pH(pHi)value in elderly patients undergoing lumbar spine surgery.Methods One hundred and sixty elderly patients of either sex,aged 65-80 yr,of American Society of Anesthesiologists physical statusⅡorⅢ,undergoing elective lumbar spine surgery under general anesthesia,were selected and divided into 2 groups(n=80 each)using a random number table method:SVV-guided GDFT group(group G)and conventional fluid therapy group(group C).GDFT was performed with SVV<15%as the target in group G,while conventional fluid infusion was performed under the guidance of mean arterial pressure,central venous pressure and urine volume in group C.Intraoperative amount of crystalloid solution infused,amount of colloid solution infused,total volume of fluid infused,amount of bleeding,urine volume,use of vasoactive drugs and perioperative blood transfusion were recorded in both groups.Cardiac index,SVV,pHi,gastric intramucosal partial pressure of CO_(2)(PgCO_(2)),PaCO_(2) and results of arterial blood gas analysis were also recorded before induction of anesthesia(T_(1)),at 1 h after the start of surgery(T_(2))and at the end of surgery(T_(3)).The postoperative complications,time to first flatus,time to defecation and duration of hospital stay were also recorded in both groups.Results Compared with group C,the amount of intraoperative crystalloid solution infused,total volume of fluid infused,urine volume and requirement for vasoactive drugs were significantly decreased,the amount of colloid solution infused was increased,cardiac index and pHi value were increased at T_(2),3,and SVV,Pg-aCO_(2) and arterial blood lactic acid concentrations were decreased(P<0.05),and no significant changes were found in the intraoperative amount of bleeding,arterial blood pH value,PaCO_(2) and base excess,incidence of postoperative complications,time to first flatus,time to defecation and duration of hospital stay in group G(P>0.05).Conclusions GDFT based on SVV guidance is superior to traditional fluid therapy in improving splanchnic perfusion in elderly patients undergoing lumbar spine surgery.