摘要
目的观察应用超声监测的下腔静脉塌陷率(IVC-CI)来指导老年患者全身麻醉前快速补液效果,探讨其在减少诱导期低血压中的价值。方法选取老年择期手术患者80例,随机分为观察组和对照组,各40例。观察组患者使用超声监测IVC-CI,对IVC-CI<40%者直接麻醉诱导,对IVC-CI≥40%患者给予3 ml/kg的复方氯化钠溶液,动态监测和快速补液,直至IVC-CI<40%或总输液量达到9 ml/kg再诱导。对照组患者按8 ml/kg·h补液,待手术医生入室后开始麻醉诱导。比较两组血压、心率变化及术中升压药使用情况。结果观察组所有患者补液后均能达到IVC-CI<40%,未出现补液不良反应,两组患者的血压、心率在诱导后均有降低,但对照组血压降低更显著,低血压发生率和升压药使用率均明显增高,差异有统计学意义(P<0.05)。结论采用超声监测IVC-CI指导老年患者进行麻醉前快速补液,可显著改善诱导后低血压的发生,能安全有效的实现个体化的液体输注,具有临床实用价值。
Objective To observe ultrasound-monitored inferior vena cava collapse rate(IVC-CI)to guide rapid rehydration before general anesthesia in elderly patients,and to explore its value in reducing hypotension during induction.Methods 80 elderly patients with elective surgery were selected and randomly divided into observation group and control groupwith 40 cases in each group.In observation group,ultrasound was used to monitor IVC-CI.When IVC-CI<40%,anesthesia was directly induced.When IVC-CI≥40%,3 ml/kg compound sodium chloride solution was given.After dynamic monitoring and rapid rehydration,IVC-CI<40%or total infusion volume reached 9 ml/kg,it was time to induce.In control group,8 ml/kg·h fluid was given,and anesthesia induction was started after surgeon entered room.Changes in blood pressure,heart rate and intraoperative blood pressure drugs were compared between two groups.Results All patients in observation group were able to achieve IVC-CI<40%after rehydration,and there were no adverse reactions of rehydration.Blood pressure and heart rate of two groupswere reduced after induction,but blood pressure of control group decreased more significantly,and incidence of hypotension was blood pressure drugs increased significantly with statistically significant difference(P<0.05).Conclusion Using ultrasound monitoring IVC-CI to guide elderly patients to perform rapid fluid rehydration before anesthesia could significantly reduce hypotension after induction,and could safely and effectively achieve individualized fluid infusion,which has clinical practical value.
作者
王宇
高志勇
唐一植
薛静
雷鸣
唐作垒
Wang Yu;Gao Zhiyong;Tang Yizhi(Chengdu 363 Hospital Affiliated to Southwest Medical University,Chengdu,Sichuan 610041,China)
出处
《四川医学》
CAS
2020年第12期1227-1230,共4页
Sichuan Medical Journal
基金
四川省卫生和计划生育委员会科研课题(编号:18PJ166)。
关键词
超声
下腔静脉塌陷率
老年患者
麻醉诱导
低血压
ultrasound
inferior vena cava collapse rate
elderly patients
anesthesia induction
hypotension
