目标导向液体治疗联合超声动态监测血管外肺水在老年全髋关节置换病人液体管理中的应用

Clinical application of goal-directed fluid therapy combined with ultrasound-guided dynamic monitoring of extravascular pulmonary water in elderly patients receiving total hip arthroplasty

目的探讨目标导向液体治疗(GDFT)联合超声动态监测血管外肺水(EVLW)在老年全髋关节置换(THA)病人中的应用。方法选取建湖县人民医院实施THA手术治疗的97例老年病人,随机分为2组:观察组(n=48)实施GDFT,对照组(n=49)采用常规围手术期液体管理方式。对比2组病人不同时间点的平均动脉压(MAP)、心率(HR)、心指数(CI)、每搏输出量指数(SVI)、血乳酸含量、氧和指数(OI)、气道峰压(PIP)及肺部相关并发症发生率。同时,采用肺部超声检查进行B线评分,监测EVLW。结果观察组的补液总量明显少于对照组,差异具有统计学意义(P<0.01)。观察组气管插管30 min、术毕时的MAP和B线评分均低于对照组(P<0.05);观察组气管插管15 min、30 min的CI和气管插管30 min的SVI均高于对照组(P<0.05);观察组气管插管15 min、30 min、术毕的血乳酸和PIP水平均低于对照组,OI均高于对照组(P<0.05)。观察组肺部并发症发生率明显低于对照组,差异具有统计学意义(4.2%比16.3%,P<0.05)。结论老年THA病人实施GDFT联合超声动态监测EVLW有利于补充适宜的液体总量,维持血流动力学稳定,降低肺部并发症发生率,保护肺功能。

Objective To explore the value of goal-directed fluid therapy(GDFT)combined with ultrasound-guided dynamic monitoring of extravascular lung water(EVLW)in the elderly patients receiving total hip arthroplasty(THA).Methods A total of 97 elderly patients who underwent THA surgery at Jianhu County People’s Hospital were enrolled and randomly divided into the observation group(n=48)and the control group(n=49).The observation group received GDFT,while the control group received conventional perioperative fluid management.The levels of mean arterial pressure(MAP),heart rate(HR),cardiac index(CI),stroke volume index(SVI),blood lactic acid,oxygen index(OI),peak airway pressure(PIP),and the incidence of pulmonary-related complications were recorded and compared between the two groups at different time points.Meanwhile,score of B line was observed by lung ultrasomd and EVLW was monitored.Results The fluid replenishment amount in the observation group was significantly lower than that in the control group(P<0.01).The level of MAP and B line score in the observation group 30 min after tracheal intubation and after the operation were significantly lower than those in the control group(P<0.05).The level of CI 15 min,30 min after tracheal intubation and the level of SVI 30 min after tracheal intubation in the observation group were significantly higher than those in the control group(P<0.05).The levels of blood lactic acid and PIP 15 min,30 min after tracheal intubation and after the operation in the observation group were significantly lower and the level of OI was higher than those in the control group(P<0.05).There was significant difference in the incidence rate of pulmonary complications between the observation group and the control group(4.2%vs 16.3%,P<0.05).Conclusions For elderly patients undergoing THA,GDFT combined with ultrasound-guided dynamic monitoring of EVLW can help to supplement the appropriate total amount of fluid and maintain stable hemodynamics,reduce the incidence of lung complications,protect the lung function.