摘要
目的研究每搏变异度(SVV)指导下补液对硬膜外麻醉复合全身麻醉老年腹腔镜手术患者应激反应及预后的影响。方法选取2017年9月—2019年9月行硬膜外麻醉复合全身麻醉的老年腹腔镜手术患者130例为研究对象,按照补液方法不同分为观察组和对照组,每组65例。观察组以SVV值为指导进行补液,对照组按常规4/2/1补液原则进行补液。比较2组围手术期情况及手术后并发症情况;比较2组麻醉前(T0)、气腹建立后(T1)及手术结束时(T2)血流动力学指标、微循环灌注指标、应激因子指标。结果观察组输液总量、重症监护病房停留时间、留置引流管时间以及并发症总发生率均低于对照组(P<0.05)。T1时,2组心率高于T0和T2时,平均动脉压、心脏指数低于T0和T2时(P<0.05)。T1、T2时,2组中心静脉血氧饱和度(ScvO 2)、氧输送指数(DO 2I)、乳酸(Lac)、去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)均高于T0时,且T2时ScvO 2、DO 2I、Lac高于T1时,T1时NE、E、Cor高于T2时(P<0.05);T1、T2时,观察组ScvO 2、DO 2I高于对照组,Lac、NE、E、Cor低于对照组(P<0.05)。结论SVV指导下补液能减轻硬膜外麻醉复合全身麻醉老年腹腔镜手术患者的应激反应,改善器官灌注,并减少术后并发症。
Objective To study the effect of rehydration guided by stroke volume variation(SVV)on stress response and prognosis of elderly patients undergoing laparoscopic surgery under epidural anesthesia combined with general anesthesia.Methods A total of 130 elderly patients undergoing laparoscopic surgery under epidural anesthesia combined with general anesthesia from September 2017 to September 2019 were selected as the research subjects.They were divided into observation group and control group according to different rehydration methods,with 65 cases in each group.The observation group received rehydration under the guidance of SVV value,while the control group was rehydrated according to conventional 4/2/1 rehydration principle.The perioperative and postoperative complications were compared between the two groups.Hemodynamic indexes,microcirculatory perfusion indexes and stress factor indexes before anesthesia(T0),after pneumoperitoneum establishment(T1)and at the end of operation(T2)were compared between the two groups.Results The total amount of infusion,length of ICU stay,the total length of indwelling catheter and the incidence of complications in the observation group were lower than those in the control group(P<0.05).At T1,the heart rate in two groups was higher than that at T0 and T2,mean arterial pressure and cardiac index were lower than those at T0 and T2(P<0.05).At T1 and T2,the central venous oxygen saturation(ScvO 2),oxygen transport index(DO 2I),lactic acid(Lac),norepinephrine(NE),epinephrine(E)and cortisol(Cor)in both groups were higher than those at T0,ScvO 2,DO 2I and Lac at T2 were higher than those at T1,and NE,E and Cor at T1 were higher than those at T2(P<0.05).At T1 and T2,ScvO 2 and DO 2I in the observation group were higher than those in the control group,while Lac,NE,E and Cor in the observation group were lower than those in the control group(P<0.05).Conclusion Rehydration under the guidance of SVV can reduce the stress response of elderly patients undergoing laparoscopic surgery under epidur
作者
周红荣
姜荣强
吕大鹏
边兴花
ZHOU Hong-rong;JIANG Rong-qiang;LYU Da-peng;BIAN Xing-hua(Department of Anesthesiology,Traditional Chinese Medicine Hospital of Hengshui,Hengshui,Hebei 053000,China;Department of Anesthesiology,the Fourth People's Hospital of Hengshui,Hengshui,Hebei 053000,China;Department of Anesthesiology,the First Hospital of Zhangjiakou,Zhangjiakou,Hebei 075000,China)
出处
《解放军医药杂志》
CAS
2020年第9期98-102,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
河北省医学科学研究重点课题计划项目(20181173)。
关键词
每搏变异度
麻醉
硬膜外
全身麻醉
老年人
腹腔镜手术
补液
Stroke volume variation
Anesthesia,epidural
General anesthesia
Aged
Laparoscopic surgery
Rehydration
