目标导向液体治疗在B型主动脉夹层患者冠状动脉搭桥手术中的疗效分析

Analysis of the efficacy of target-oriented infusion therapy in coronary artery bypass surgery in patients with type B aortic dissection

目的探讨目标导向液体治疗在B型主动脉夹层患者冠状动脉搭桥手术中的疗效。方法收集2019年6月至2022年6月于河北医科大学第一医院接受冠状动脉搭桥手术治疗的82例B型主动脉夹层患者的临床资料,按照治疗方法的不同将其分为观察组(n=50,采用目标导向液体治疗)与对照组(n=32,采用常规液体治疗)。比较两组患者术前30 min(T_(0))、麻醉诱导后15 min(T_(1))、术中l h(T_(2))、术中2 h(T_(3))、术毕(T_(4))时脑氧饱和度(rSO_(2))、中心静脉血氧饱和度(ScvO_(2))、容量负荷指标[心排血量(CO)、每搏量变异度(SVV)]、血流动力学指标[平均动脉压(MAP)、心率(HR)、心排血指数(CI)、中心静脉压(CVP)]、血乳酸(LAC)水平及术后并发症发生情况。结果两组患者手术时间、术中低体温、术中出血量比较,差异均无统计学意义(P﹥0.05)。T_(2)~T_(4)时,观察组患者CO、rSO_(2)、ScvO_(2)、CI均高于对照组患者,SVV、CVP、LAC水平低于对照组患者,差异均有统计学意义(P﹤0.05);两组患者MAP、HR比较,差异均无统计学意义(P﹥0.05)。两组患者胸痛、休克、主动脉破裂发生率比较,差异均无统计学意义(P﹥0.05)。观察组患者住院期间谵妄发生率为12.0%(6/50),低于对照组患者的31.3%(10/32),差异有统计学意义(P﹤0.05)。结论目标导向液体治疗能显著改善B型主动脉夹层患者冠状动脉搭桥手术患者围手术期心脏功能,提高rSO_(2),降低谵妄的发生率,值得临床进一步推广应用。

Objective To investigate the efficacy of target-oriented infusion therapy in coronary artery bypass surgery in patients with type B aortic dissection.Method The clinical data of 82 patients with type B aortic dissection who underwent coronary artery bypass surgery at the First Hospital of Hebei Medical University from June 2019 to June 2022 were collected.They were divided into observation group(n=50,using goal-directed fluid therapy)and control group(n=32,using conventional fluid therapy)according to different treatment methods.The cerebral oxygen saturation(rSO_(2)),central venous oxygen saturation(ScvO_(2)),volume load indicators[cardiac output(CO),stroke volume variability(SVV)],hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR),cardiac index(CI),central venous pressure(CVP)],blood lactate(LAC)levels 30 minutes before the operation(T_(0)),15 minutes after the induction of anesthesia(T_(1)),1 h during the operation(T_(2)),2 h during the operation(T_(3)),and at the end of the operation(T_(4))and postoperative complications of the two groups of patients were compared.Result There were no statistically significant differences in the operation time,intraoperative hypothermia,and intraoperative blood loss between the two groups of patients(P>0.05).From T_(2)to T_(4),the CO,rSO_(2),ScvO_(2),and CI of the patients in the observation group were higher than those of the patients in the control group,the SVV,CVP,and LAC were lower than those of the patients in the control group,the differences were statistically significant(P<0.05).The differences were not statistically significant between the two groups in terms of the MAP,HR(P>0.05).There were no statistically significant differences in the incidence rates of chest pain,shock,and aortic rupture between the two groups(P>0.05).The incidence of delirium during hospitalization in the observation group was 12.0%(6/50),lower than 31.3%(10/32)of the patients in the control group,the difference was statistically significant(P<0.05).Conclusion Target-oriented infusion therapy is worthy of further promotion and application in clinical practice as its remarkable improvement on perioperative cardiac function in type B aortic dissection patients during coronary artery bypass surgery with rSO_(2)up-regulation and lower risk of delirium.