摘要
目的探讨脉搏变异指数(PVI)指导下的目标导向液体治疗在腹腔镜肠道肿瘤手术中的临床应用价值。方法选取2018年1月~2019年7月于我院择期行腹腔镜肠道肿瘤手术的40例患者作为研究对象,按照随机数字表法将其分为S组和D组,每组各20例。S组患者以PVI指导术中液体治疗,D组患者则根据心率(HR)、血压、中心静脉压(CVP)等指标综合判断进行术中液体治疗。记录两组患者入室(T1)、麻醉诱导插管后(T2)、气腹建立后5 min(T3)、剥除肿瘤时(T4)、放气腹后5 min(T5)和术毕(T6)各时间点的血流动力学指标[平均动脉压(MAP)、HR、CVP、PVI、脉搏灌注指数(PI)],并于T1及T6时检测动脉血乳酸(Lac)浓度;记录两组的手术时间、总输液量、尿量、失血量及术中麻醉药物使用情况,观察两组的术后排气时间及肺部、消化道不良事件发生率。结果两组患者T1~T3、T5~T6时的MAP、HR、CVP、PVI、PI比较,差异无统计学意义(P>0.05);T4时,S组患者的HR[(64.00±6.62)次/min]低于D组[(73.89±8.08)次/min],差异有统计学意义(P<0.05)。两组患者的手术时间、尿量、失血量及术中麻醉药物使用情况比较,差异无统计学意义(P>0.05);S组患者总输液量[(2502.53±347.62)ml]少于D组[(2778.60±366.62)ml],差异有统计学意义(P<0.05)。S组患者的术后排气时间[(56.52±29.66)h]短于D组[(82.67±40.71)h],差异有统计学意义(P<0.05);两组患者的肺部不良事件发生率比较,差异无统计学意义(P>0.05);S组患者的消化道不良事件发生率(5.0%)低于D组(30.0%),差异有统计学意义(P<0.05)。结论PVI用于指导腹腔镜肠道肿瘤手术中的液体治疗,在维持循环稳定的同时能减少液体输入量,有利于患者术后快速恢复,减少胃肠道不良事件的发生,值得临床推荐。
Objective To explore the clinical application value of goal-directed fluid therapy under the guidance of pulse variability index(PVI)in laparoscopic intestinal tumor surgery.Methods Forty patients who underwent elective laparoscopic intestinal tumor surgery in our hospital from January 2018 to July 2019 were selected as the research subjects,and they were divided into group S and group D according to the random number table method,20 cases in each group.Patients in group S were guided by PVI for intraoperative fluid therapy,and patients in group D were judged comprehensively for intraoperative fluid therapy based on indicators such as heart rate(HR),blood pressure,and central venous pressure(CVP).The hemodynamic indicators(mean arterial pressure[MAP],HR,CVP,PVI,pulse perfusion index[PI])at the following time points were recorded in the two groups of patients,like room admission(T1),after anesthesia intubation(T2),5 minutes after the pneumoperitoneum was established(T3),when the tumor was removed(T4),5 minutes after the deflation of the abdomen(T5),and the completion of the surgery(T6).The surgery time,total infusion volume,urine volume,blood loss and intraoperative anesthetic drug use of the two groups were recorded,and the postoperative exhaust time,the incidence of lung and gastrointestinal adverse events in the two groups were observed.Results There were no significant differences in MAP,HR,CVP,PVI,and PI at T1-T3 and T5-T6 between the two groups(P>0.05).At T4,the HR of group S([64.00±6.62]times/min)was lower than that of group D([73.89±8.08]times/min),and the difference was statistically significant(P<0.05).There were no statistically significant differences in surgery time,urine volume,blood loss and intraoperative anesthetic drug use between the two groups(P>0.05).The total infusion volume of patients in group S([2502.53±347.62]ml)was less than that in group D([2778.60±366.62]ml),and the difference was statistically significant(P<0.05).The postoperative exhaust time of group S([56.52±29.66]h)was shorte
作者
罗锐
朱雁鸿
廖飞
LUO Rui;ZHU Yan-hong;LIAO Fei(Department of Anesthesiology,People′s Hospital of Yuxi City,the Sixth Affiliated Hospital of Kunming Medical University,Yunnan Province,Yuxi 653100,China)
出处
《中国当代医药》
2020年第13期18-21,共4页
China Modern Medicine
关键词
脉搏变异指数
目标液体导向治疗
腹腔镜
肠道肿瘤
补液
Pulse variability index
Goal-directed fluid therapy
Laparoscopy
Intestinal tumor
Rehydration
