中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2019, Vol. 48 ›› Issue (3): 265-268.doi: 10.12007/j.issn.0258-4646.2019.03.015

• 论著 • 上一篇    下一篇

目标导向液体治疗在胰十二指肠切除术中的临床应用

邢英皓, 潘柏言, 吴秀英   

  1. 中国医科大学附属盛京医院麻醉科, 沈阳 110004
  • 收稿日期:2018-01-15 出版日期:2019-03-30 发布日期:2019-03-06
  • 通讯作者: 吴秀英 E-mail:wuxy@sj-hospital.org
  • 作者简介:邢英皓(1991-),女,医师,硕士.

Clinical Applications of Goal-directed Fluid Therapy for Pancreatoduodenectomy

XING Yinghao, PAN Boyan, WU Xiuying   

  1. Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2018-01-15 Online:2019-03-30 Published:2019-03-06

摘要: 目的 探讨目标导向液体治疗在胰十二指肠切除术中的临床应用。方法 选取择期全麻下行胰十二指肠切除术的患者40例,随机分为G组和C组,每组各20例。G组采用目标导向液体治疗,C组采用常规补液治疗。记录手术期间的血流动力学指标、液体出入量、术后首次排气时间、术后肾功能指标、血清乳酸及术后并发症的发生情况。结果 与C组相比,G组在手术1 h~术毕时心指数增加、每搏变异度下降(P < 0.05),平均动脉压在手术3 h~术毕时上升(P < 0.05)。G组术中晶体液入量、输液总量均小于C组(P < 0.05),血管活性药物使用例数多于C组(P < 0.05)。G组术后首次排气时间较C组有良好的转归趋势(P < 0.05)。2组患者术后的血清乳酸、血尿素氮、肌肝及术后并发症发生率等方面差异均无统计学意义(P > 0.05)。结论 对于胰十二指肠切除术这类复杂大手术,目标导向液体治疗能更加精确地指导术中液体治疗,具有个体优化性,在维持术中血流动力学稳定及改善患者术后转归方面更具优势。

关键词: Flotrac/Vigileo, 目标导向液体治疗, 胰十二指肠切除术

Abstract: Objective To investigate the clinical applications of goal-directed fluid therapy for pancreatoduodenectomy. Methods A total of 40 patients undergoing pancreatoduodenectomy under general anesthesia were randomly divided into two groups,G and C,with 20 cases in each group. Goal-directed fluid therapy was used in Group G,whereas conventional fluid therapy was used in group C. The intraoperative hemodynamics,liquid management,duration of the first postoperative gastrointestinal ventilation,postoperative renal function,serum lactate,and the incidence of postoperative complications were recorded. Results Compared with group C,the CI increased and SVV decreased (P < 0.05) at T3 to T5,and MAP increased at T4 to T5 (P < 0.05). The amount of fluid infusion and total infusion in group G were less than that of group C (P < 0.05),and the number of vasoactive drugs was greater than that of group C (P < 0.05). The duration of the first postoperative gastrointestinal ventilation in group G was shorter than that of group C (P < 0.05). There were no significant differences between the 2 groups for the incidence of serum lactate,BUN,Cr,and the incidence of postoperative complications (P > 0.05). Conclusion For major complex operations,such as pancreaticoduodenectomy,goal-directed fluid therapy can guide intraoperative fluid therapy more accurately with individual optimizations,and has more advantages in maintaining intraoperative hemodynamics stability and improving postoperative outcome.

Key words: Flotrac/Vigileo, goal-directed fluid therapy, pancreaticoduodenectomy

中图分类号: 

  • R614
[1] 孙艳霞,柴芳,潘楚雄,等. 目标导向液体治疗对腹部手术后转归的影响:meta分析[J]. 中华麻醉学杂志,2017,37(5):558-564. DOI:10.3760/cma.j.issn.0254-1416.2017.05.013.
[2] TRINOOSON CD,GOLD ME. Impact of goal-directed perioperative fluid management in high-risk surgical procedures:a literature review[J]. Aana J,2013,81(5):357-368.
[3] 谢凤鸣. 胰十二指肠切除术后早期并发症的危险因素分析及干预对策[J]. 中外医学研究,2016,14(2):32-34. DOI:10.3969/j.issn.1672-9455.2013.21.017.
[4] 吴文华,高慧平,马风珍. 胰十二指肠切除术后早期出血及腹腔感染的原因分析及干预对策[J]. 大家健康旬刊,2014,8(4):467.DOI:10.3969/j.issn.1009-6019.2014.04.588.
[5] 周涛,郭善亮,张明生. 目标导向液体治疗在老年患者胃肠道手术中的应用[J]. 临床麻醉学杂志,2013,29(10):971-974.
[6] 赵静,虞意华. 围手术期目标导向液体治疗对患者预后影响的研究进展[J]. 中华外科杂志,2016,54(12):951-954. DOI:10.3760/cma.j.issn.0529-5815.2016.12.017.
[7] PEARSE RM,HARRISON DA,MACDONALD N,et al. Effect of a perioperative,cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery:a randomized clinical trial and systematic review[J]. JAMA,2014,311(21):2181-2190. DOI:10.1001/jama.2014.5305.
[8] YATES DRA,DAVIES SJ,WARNAKULASURIYA SR,et al. Volume management and resuscitation in colorectal surgery[J]. Curr Anethesiol Rep,2014,4(4):376-385.
[9] 王文珊,李宝永,张小平,等. 目标导向液体治疗对老年胃肠道肿瘤患者肠道运动功能的影响[J]. 实用医学杂志,2016,32(6):941-944. DOI:10.3969/j.issn.1006-5725.2016.06.023.
[10] CORCORAN T,JULIA EJR,CLARKE S,et al. Perioperative fluid management strategies in major surgery:a stratified meta-analysis[J]. Anesth & Analg,2012,114(3):640-651. DOI:10.1213/ANE.0b013e318240d6eb.
[11] BENES J,GIGLIO M,BRIENZA N,et al. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome:a meta-analysis of randomized controlled trials[J]. Crit Care,2014,18(5):584. DOI:10.1186/cc8875.
[12] 赵国良,周银燕,彭沛华,等. 目标导向液体治疗对胃肠道肿瘤手术老年患者术后康复的影响[J]. 中华麻醉学杂志,2015,35(4):453-456.
[13] 王天龙. 目标导向液体治疗在围术期的应用[J]. 北京医学,2014(8):620-621. DOI:10.3969/j.issn.0253-9713.2014.08.003.
[14] CHALLAND C,STRUTHERS R,SNEYD JR,et al. Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery[J]. British J Anaesthesia,2012,108(1):53. DOI:10.1093/bja/aer273.
[1] 孙赫. 胰十二指肠切除术后胰瘘的危险因素及胰肠吻合方式分析[J]. 中国医科大学学报, 2018, 47(7): 622-625.
[2] 阴俊, 张锦. 胰十二指肠切除术后罗哌卡因切口局部浸润的镇痛效果[J]. 中国医科大学学报, 2018, 47(2): 162-166.
[3] 孙叶飞,李华. 38例胰十二指肠切除术围手术期护理体会[J]. 中国医科大学学报, 2014, 43(1): 87-89.
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