不同水平脉压变异率指导胸腔镜下肺癌手术液体治疗的研究

Study on liquid therapy of lung cancer surgery under thoracoscopy guided by different levels of pulse pressure variability

目的探讨不同水平脉压变异率(PPV)指导胸腔镜下肺癌手术液体治疗对患者的影响。方法选取2020年4月~2022年4月在我院行胸腔镜下肺癌手术的150例患者为研究对象,按照随机数字表法分为高PPV组、低PPV组和对照组,每组50例。高PPV组以10%≤PPV≤15%为目标指导液体治疗,低PPV组以1%≤PPV≤5%为目标指导液体治疗,对照组以中心静脉压、心率、血压、尿量等指标指导液体治疗。记录三组患者麻醉诱导前(T1)、麻醉诱导后(T2)、单肺通气后30min(T3)、手术结束时(T4)、术后24h(T5)的心率、平均动脉压和乳酸(Lac)水平。比较三组患者相关临床指标、肺功能及术后并发症发生情况。结果T2、T3时刻,高PPV组、低PPV组平均动脉压均高于对照组,差异有统计学意义(P<0.05);T3时刻,低PPV组Lac水平低于高PPV组和对照组,差异有统计学意义(P<0.05)。高PPV组、低PPV组液体输入总量低于对照组,且总住院时间短于对照组,差异有统计学意义(P<0.05)。低PPV组液体输入总量高于高PPV组,但总住院时间短于高PPV组,差异有统计学意义(P<0.05)。术后3d,三组间第1s用力呼吸容积(FEV1)、用力肺活量(FVC)、FEV1/FVC比较差异无统计学意义(P>0.05)。低PPV组和高PPV组并发症总发生率均为8.0%,均显著低于对照组的34.0%,差异有统计学意义(P<0.05)。结论以低PPV为目标指导液体治疗有助于稳定肺癌手术患者血流动力学指标,降低术中Lac水平及术后并发症发生率,促进术后康复。

Objective To explore the effect of liquid therapy guided by different levels of pulse pressure variability(PPV)on patients with lung cancer surgery under thoracoscopy.Methods 150 patients who underwent thoracoscopic lung cancer surgery in our hospital from Apr 2020 to Apr 2022 were randomly divided into high PPV group,low PPV group and control group,with 50 cases in each group.Liquid therapy was guided by 10%≤PPV≤15%in the high PPV group,liquid therapy was guided by 1%≤PPV≤5%in the low PPV group,and liquid therapy was guided by central venous pressure,heart rate,blood pressure,urine volume and other indicators in the control group.The heart rate,mean arterial pressure and lactic acid(Lac)of the three groups were recorded before anesthesia induction(T1),after anesthesia induction(T2),30min after one lung ventilation(T3),the end of operation(T4)and 24h after operation(T5).The related clinical indexes,pulmonary function and postoperative complications of the three groups were compared.Results At T2 and T3 time,the mean arterial pressure of the high PPV group and the low PPV group was higher than that of the control group(P<0.05).At T3 time,the Lac level of the low PPV group was lower than that of the high PPV group and the control group(P<0.05).The total amount of fluid input in the high PPV group and the low PPV group was lower than that in the control group,and the total length of hospital stay was shorter than that in the control group(P<0.05).The total amount of fluid input in the low PPV group was higher than that in the high PPV group,but the total length of hospital stay was shorter than that in the high PPV group(P<0.05).Three days after operation,there was no significant difference in FEV1,FVC and FEV1/FVC among the three groups(P>0.05).The total incidence of complications in the low PPV group and the high PPV group all was 8.0%,which was significantly lower than 34.0%in the control group(P<0.05).Conclusion Liquid therapy guided by low PPV is helpful for stabilizing the hemodynamic indexes of patients with lung cancer surgery,reducing the incidence of postoperative complications and promoting postoperative rehabilitation.