| 谢芳华.基于每搏量变异度及心指数导向的老年患者开胸肺叶切除术液体管理的临床研究[J].浙江中西医结合杂志,2015,25(10): |
| 基于每搏量变异度及心指数导向的老年患者开胸肺叶切除术液体管理的临床研究 |
| Clinical research of goal-directed fluid management based on the cardiac index and stroke volume variation in geriatric patients undergoing thoracic lobectomy. |
| 投稿时间：2014-07-10 修订日期：2015-08-23 |
| DOI： |
| 中文关键词: 老年患者 开胸肺叶切除术 每搏变异度 液体治疗 |
| 英文关键词:Geriatric patients Thoracic lobectomy stroke volume variation Fluid Therapy |
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| 中文摘要: |
| 【】目的 观察以每搏量变异度(stroke volume variation,SVV)和心指数(cardiac index,CI)为导向的液体管理策略对行开胸肺叶切除术的老年患者术后转归的影响。方法 60例行择期肺叶切除术的患者,年龄在65岁至80岁之间,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以SVV为导向的GDT组(30例)和以中心静脉压为导向(central venous pressure,CVP)的C组(30例),监测围术期两组指标,包括心率、平均动脉压、气道压力(airway pressure,Pmax)、动脉血气分析等,评价以SVV为导向的围术期液体管理策略在改善患者术后转归方面是否优于传统的以CVP为指导的液体管理策略。结果 GDT组单肺通气结束前10分钟以及双肺通气后送ICU前的氧合指数明显高于对照组。两组术中胶体输入量、术中输液总量,GDT组显著少于C组,术中尿量及术后拔管时间,GDT组也显著少于C组。两组患者术后并发症中的肺水肿、肺不张、再插管的发生率两组间差异无统计学意义,而C组高血压的发生率明显高于GDT组,余无特殊。 |
| 英文摘要: |
| 【】Objective To evaluate the influence of goal-directed fluid management strategies based on cardiac index and stroke volume variation in geriatric patients undergoing thoracic lobectomy．Methods Sixty patients undergoing elective lobectomy,age range from 65 to 80Y,ASA I—II,were randomly assigned to the GDT group and the C group．The parameters including heart rate(HR),mean arterial pressure(MAP),airway pressure(Pmax)and arterial blood gas analysis were recorded．SVV and CI-directed fluid management strategy and the traditional CVP guided fluid management strategy were compared by clinical outcomes．Results There was no statistically significant difference in general informations between the two groups．No statistically significant difference in HR,MAP,Sp02,Pmax was found．The PaO2/FiO2-ratio before the end of one-lung ventilation and entering the ICU in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes.The incidence of post-operation hypertension was lower in goal-directed therapy group than control group. |
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