摘要
目的探究麻醉期间目标导向液体治疗（goal-directed therapy,GDT）对肺叶切除手术后急性肺损伤的影响,为肺叶切除患者液体管理提供依据。方法选择第四军医大学第二附属医院（唐都医院）胸外科2013年5月-2015年4月80例行胸腔镜下右肺下叶切除术患者,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对照组（C组）40例和目标导向组（G组）40例。C组根据术中平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）、中心静脉压（central venous pressure,CVP）等行常规液体治疗方案治疗;G组在Vigileo监护仪指导下,根据每搏量变异度（stroke volume variation,SVV）监测值行目标导向液体治疗。监测围术期两组心率、心指数（cardiac index,CI）、平均动脉压和中心静脉氧饱和度（Scv O2）等指标,并监测术中血流动力学指标计算氧供指数（DO2I）,同时记录术后相关并发症发生率及术后住院时间。结果 G组术中HR、MAP和CI与C组比较差异无统计学意义。G组术中输液量（1 180±213）ml,术后液体输入的正平衡量（421±189）ml,明显小于C组的（1 950±426）ml和（879±243）ml（P〈0.05）。术后重症监护室（ICU）驻留时间和氧合指数等指标G组较C组呈现良好转归。G组患者术后急性肺损伤等肺部相关并发症的发生率明显低于C组。结论麻醉期GDT能够降低肺叶切除手术后急性肺损伤等并发症的发生率。
Objective To discuss the effects of goal-directed therapy（GDT） during anesthesia on patients with acute lung injury undergoing pulmonary lobectomy and provide theoretical foundation for fluid management in pulmonary lobectomy. MethodsEighty patients undergoing pulmonary lobectomy in Tangdu Hospital, Fourth Military Medical University from May 2013 to April 2014 were randomly divided into control group（grouP〈0C, n=40） and goal-directed group（grouP〈0G, n=40）. Patients in grouP〈0C received conventional fluid therapy with mean arterial pressure（MAP）, heart rate（HR） and central venous pressure（CVP） measurement etc, while those in grouP〈0G received GDT according to stroke volume variation（SVV） guided by Vigileo monitor. The parameters including HR, MAP, cardiac index（CI） and central venous oxygen saturation（Scv O2） were recorded. Clinical data about patients after operation, including pulmonary infection, pulmonary atelectasis, pulmonary edema and hospital stay, were recorded. Results There was no statistically significant difference in general information between two groups. No statistically significant differences in HR, MAP〈0and CI were found. Fluid intake during operation and positive fluid balance during post-operation period were significantly lower in grouP〈0G compared with grouP〈0C [（1 180±213） ml vs（1 950±426） ml,（421±189） ml vs（879±243） ml, P〈0.05]. The stay time in ICU of grouP〈0G was shorter than grouP〈0C, while the oxygen index of grouP〈0G was higher than grouP〈0C. The incidence of pulmonary complications such as acute lung injury was significantly lower in grouP〈0G than grouP〈0C. Conclusion GDT during anesthesia decreases the incidence of pulmonary complications such as acute lung injury after pulmonary lobectomy and improves clinical outcomes in patients undergoing pulmonary lobectomy.
出处
《解放军医学院学报》
CAS
2015年第11期1109-1112,共4页
Academic Journal of Chinese PLA Medical School
关键词
麻醉
肺叶切除
目标导向液体治疗
急性肺损伤
anesthesia
pulmonary lobectomy
goal-directed therapy
acute lung injury
