国际麻醉学与复苏杂志   2013, Issue (5): 1-1
    
以心指数/每搏指数/每搏量变异度为导向的老年患者开胸肺叶切除术液体管理的临床研究
李燕虹, 王天龙, 赵磊1()
1.首都医科大学宣武医院麻醉科
Clinical research of goal-directed fluid management based on the cardiac index/stroke volume index/stroke volume variation in geriatric patients undergoing thoracic lobectomy
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摘要:

目的 观察以心指数/每搏指数/每搏量变异度(cardiac index/stroke volume index/stroke volume variation, CI/SVI/SVV )为导向的液体管理策略对行开胸肺叶切除术的老年患者术后转归的影响。方法 30例行择期肺叶切除术的患者,年龄≥65岁,美国麻醉医师协会(ASA)分级I~II级,采用随机数字表法随机分为以CI/SVI/SVV为导向的S组(15例)和以中心静脉压(central venous pressure, CVP)为导向的C组(15例),监测围术期两组指标,包括心率(heart rate, HR)、平均动脉压(mean arterial pressure, MAP)、 动脉血氧饱和度(arterial oxygen saturation, SpO2)、呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure, PETCO2)、气道压力(airway pressure, Pmax)、 脑电双频指数(bispectral index, BIS)等,评价以CI/SVI/SVV为导向的围术期液体管理策略在改善患者术后转归方面是否优于传统的以CVP为指导的液体管理策略。结果 S组患者术中不同观察时间点HR,MAP,SpO2,PETCO2,Pmax,BIS与C组比较差异无统计学意义。S组患者术中输液量(1 310±310)ml、术后液体输入的正平衡量(516±412)ml明显小于C组患者(1 820±459)、(757±667)ml(P<0.05),术后重症监护室(ICU)驻留时间、氧合指数等指标S组较C组呈现良好的转归趋势。C组患者术后高血压的发生率(40%)明显高于S组(6.67%)(P<0.05),余无特殊。结论 以CI/SVI/SVV为导向的老年胸科手术围术期液体管理策略较传统的以CVP为导向的液体管理具有创伤小、操作简便、液体管理更具个性化等优点,有助于改善老年患者术后转归。

关键词: 老年患者;开胸肺叶切除术;动脉血压连续心输出量监测;目标导向;麻醉;液体管理;术
Abstract:

Objective To evaluate the influence of goal-directed fluid management strategies based on cardiac index/stroke volume index/stroke volume variation (CI/SVI/SVV) in geriatric patients undergoing thoracic lobectomy. Methods Thirty patients undergoing elective lobectomy, age ≥ 65 y, ASA I-II, were randomly assigned to the S group (CI/SVI/SVV-directed, n=15) and the C-group (CVP-directed, n=15). The parameters including heart rate (HR), mean arterial pressure (MAP), arterial oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PETCO2), airway pressure (Pmax) and bispectral index (BIS) were recorded. CI/SVI/SVV-directed fluid management strategy and the traditional CVP guided fluid management strategy were compared by clinical outcomes. Results There was no statistically significant difference in general informations between the two groups. No statistically significant difference in HR, MAP, SpO2, PETCO2, Pmax and BIS was found. Fluid intake during operation (1 310±310)ml and positive fluid balance during post-operation period(516±412)ml were lower in the S group compared with the C group(1 820±459),(757±667)ml (P<0.05). The stay time in ICU of S group was shorter than C group, while the oxygen index of S group was higher than C group. The incidence of post-operation hypertension was lower in S group (6.67%) than C group (40%) (P <0.05). Conclusions CI/SVI/SVV-directed geriatric perioperative fluid management strategy is more noninvasive and managable than the traditional CVP guided fluid management. The Individual CI/SVI/SVV-directed fluid management strategy is beneficial to improve postoperative outcome of geriatric patients .

Key words: Geriatric patients; Thoracic lobectomy; Arterial pressure-based cardiac output; Goal-directed therapy; Anesthesia; Fluid management; Postoperative outcome