| 张萌,孟香弟,王立伟,等.以每搏量变异度 <17%为目标导向的液体治疗在老年病人腹腔镜胃癌根治术中的可行性及有效性[J].安徽医药,2023,27(12):2389-2393. |
| 以每搏量变异度 <17%为目标导向的液体治疗在老年病人腹腔镜胃癌根治术中的可行性及有效性 |
| Feasibility and effectiveness of SVV<17% guided goal directed fluid therapy in laparoscopic-assisted radical gastrectomy for elderly patients |
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| DOI：10.3969/j.issn.1009-6469.2023.12.012 |
| 中文关键词: 补液疗法 每搏输出量 血气监测，经皮 乳酸 气腹，人工 头高脚低位 老年人 目标导向液体治疗-动， |
| 英文关键词: Fluid therapy Stroke volume Blood gas monitoring, transcutaneous Lactic acid Pneumoperitoneum, artificial Reverse trendelenburg position Elderly patients Goal-directed fluid therapy |
| 基金项目:国家自然科学基金项目( 82071903) |
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| 中文摘要: |
| 目的探究气腹合并头高脚低位 15~30°条件下以每搏量变异度( SVV)<17%为指导的目标导向液体治疗( GDFT)在老年病人中的可行性及有效性。方法选取 2020年 1月至 2021年 6月于徐州医科大学附属医院择期行腹腔镜下胃癌根治术的老年病人 60例，采用随机数字表法分为目标组( n=30)和常规组( n=30)。常规组进行常规补液方案；目标组进行 GDFT方案。记录气管插管后 5 min(T1)气腹及体位变动后 30 min(T2)、气腹及体位变动后 1.5 h(T3)取出标本后 5 min(T4)和手术结束即刻( T5)的血流动力学及组织灌、注指标。结果目标组液体总入量( 2 142.3±156.3)mL明显、低于常规组( 2 562.7±236.5)mL(P<0.05)。两组组间比较心指数、心输出量、 SVV和每搏量均差异无统计学意义(P>0.05)。组内比较目标组和常规组在 T2时点的心率均高于其余各时点( P<0.05)；组间平均动脉压( MAP)的比较差异有统计学意义( P<0.05)。组内各时点中心静脉血氧饱和(ScvO2)的比较在目标组中时点 T2(82.8±6.1)%、T3(84.6±4.8)%、T4(83.2±5.8)%和 T5(82.4±7.2)%均高于 T1(76.9±5.8)%(P<0.05)常规组中各时点差异无统计学意义( P>0.05)；组间乳酸( aLac)、术后排气时间比较均差异有统计学意义( P<0.05)；中心静脉 脉血二氧化碳分压差( Pcv-aCO2)组间组内均差异无统计学意义( P>0.05)；两组间氧供指数、术后住院时间比较均差异无统计学意义( P>0.05)。结论基于本研究条件下的 SVV<17%为指导的术中 GDFT，可以使术中血流动力学更趋平稳，保证微循环灌注，降低术中动脉血乳酸，加快术后胃肠道功能的恢复。 |
| 英文摘要: |
| Objective To assess the feasibility and effectiveness of goal directed fluid therapy (GDFT) with a target of stroke volumevariation (SVV) <17% under the condition of pneumoperitoneum combined with reverse Trendelenburg position at 15~30° in elderlypatients.Methods Sixty elderly patients, who underwent elective laparoscopic radical gastrectomy at the Affiliated Hospital of Xu.zhou Medical University from January 2020 to June 2021, were selected and randomly assigned into the target group (n=30) and the conventional group (n=30) using random number sampling method. Patients in conventional group received routine fluid replacement,while patients in target group were treated with GDFT. The indexes of hemodynamics and tissue perfusion were collected and recordedat 5 min after intubation (T1), 30 min after pneumoperitoneum and postural changes (T2), 1.5 h (T3) after pneumoperitoneum and pos.tural changes, 5 min (T4) after specimen removal, and the time immediately after surgery (T5).Results Compared with conventional group, target group received less fluid [(2 142.3±156.3) mL vs. (2 562.7±236.5) mL, P<0.05]. There were no significant differences incardiac index (CI), cardiac output (CO), SVV and stroke volume (SV) between the two groups (P>0.05). The heart rates (HR) of the tar. get group and conventional group at T2 were higher than other time points (P<0.05). There was significant difference in the mean arteri. al pressure (MAP) between the two groups (P<0.05). Central venous oxygen saturation (ScvO2) was higher at the T2 (82.8±6.1) %, T3(84.6±4.8)% , T4 (83.2±5.8)% and T5 (82.4±7.2)% than at T1 (76.9±5.8)% in the target group (P<0.05). And in conventional group there was no statistically significant difference (P>0.05). There was significant difference in the contents of lactic acid (aLac) between the two groups (P<0.05). There was no significant difference in the central vene-arterial partial pressure of carbon dioxide (Pcv-aCO2) between the two groups (P>0.05). There was no significant difference in the oxygen supply index between the two groups (P>0.05). The time of the postoperative exhaust between the two groups was statistically significant (P<0.05). The postoperative hospital stay between the two groups was not statistically significant (P>0.05).Conclusion Intraoperatively, GDFT with a target of SVV< 17% under the conditions of this study can maintain effective circulatory volume, ensure microcirculation perfusion, and reduce intraopera.tive arterial blood lactate levels, thus accelerating the recovery of postoperative gastrointestinal function. |
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