中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
12期
1-4
,共4页
消化系统外科手术%中心静脉压%每搏量变异
消化繫統外科手術%中心靜脈壓%每搏量變異
소화계통외과수술%중심정맥압%매박량변이
Digestive system surgical procedures%Central venous pressure%Stroke volume variation
目的 探讨目标导向液体治疗对胃肠道手术患者围手术期液体管理及预后的影响.方法 选择全身麻醉下行胃肠道手术患者80例,按随机数字表法分为观察组和对照组,每组40例.对照组麻醉诱导后监测中心静脉压(CVP)指导输液治疗,使CVP在8～10mmHg(1 mmHg=0.133 kPa);观察组给予目标导向液体治疗,即监测每搏量变异(SVV)指导输液治疗,使SVV在10％～ 12％.记录两组手术时间、术中和术后3d液体管理情况;排气时间、排便时间、半流质或流质饮食时间,术后住院时间;术后48 h内并发症的发生率.结果 观察组术中输液总量、术中胶体液量、术中晶体液量明显少于对照组[(2 686.0±977.5)ml比(4 837.5±1 566.0) ml、(792.4±197.6)ml比(1 284.6±356.7) ml、(1 894.9±460.4) ml比(3 569.9±1 318.7) ml],差异有统计学意义(P＜0.05).观察组半流质饮食时间、术后住院时间明显短于对照组[(171.1±45.3)h比(235.8±89.5)h、(11.4±1.8)d比(14.7±4.9)d],差异有统计学意义(P＜0.05);两组排气时间、排便时间、流质饮食时间比较差异均无统计学意义(P＞0.05).两组术后并发症发生率比较差异无统计学意义(P＞ 0.05).结论 相对于CVP监测,胃肠道手术中给予目标导向液体治疗可以明显减少围手术期输液量,缩短术后住院时间.
目的 探討目標導嚮液體治療對胃腸道手術患者圍手術期液體管理及預後的影響.方法 選擇全身痳醉下行胃腸道手術患者80例,按隨機數字錶法分為觀察組和對照組,每組40例.對照組痳醉誘導後鑑測中心靜脈壓(CVP)指導輸液治療,使CVP在8～10mmHg(1 mmHg=0.133 kPa);觀察組給予目標導嚮液體治療,即鑑測每搏量變異(SVV)指導輸液治療,使SVV在10％～ 12％.記錄兩組手術時間、術中和術後3d液體管理情況;排氣時間、排便時間、半流質或流質飲食時間,術後住院時間;術後48 h內併髮癥的髮生率.結果 觀察組術中輸液總量、術中膠體液量、術中晶體液量明顯少于對照組[(2 686.0±977.5)ml比(4 837.5±1 566.0) ml、(792.4±197.6)ml比(1 284.6±356.7) ml、(1 894.9±460.4) ml比(3 569.9±1 318.7) ml],差異有統計學意義(P＜0.05).觀察組半流質飲食時間、術後住院時間明顯短于對照組[(171.1±45.3)h比(235.8±89.5)h、(11.4±1.8)d比(14.7±4.9)d],差異有統計學意義(P＜0.05);兩組排氣時間、排便時間、流質飲食時間比較差異均無統計學意義(P＞0.05).兩組術後併髮癥髮生率比較差異無統計學意義(P＞ 0.05).結論 相對于CVP鑑測,胃腸道手術中給予目標導嚮液體治療可以明顯減少圍手術期輸液量,縮短術後住院時間.
목적 탐토목표도향액체치료대위장도수술환자위수술기액체관리급예후적영향.방법 선택전신마취하행위장도수술환자80례,안수궤수자표법분위관찰조화대조조,매조40례.대조조마취유도후감측중심정맥압(CVP)지도수액치료,사CVP재8～10mmHg(1 mmHg=0.133 kPa);관찰조급여목표도향액체치료,즉감측매박량변이(SVV)지도수액치료,사SVV재10％～ 12％.기록량조수술시간、술중화술후3d액체관리정황;배기시간、배편시간、반류질혹류질음식시간,술후주원시간;술후48 h내병발증적발생솔.결과 관찰조술중수액총량、술중효체액량、술중정체액량명현소우대조조[(2 686.0±977.5)ml비(4 837.5±1 566.0) ml、(792.4±197.6)ml비(1 284.6±356.7) ml、(1 894.9±460.4) ml비(3 569.9±1 318.7) ml],차이유통계학의의(P＜0.05).관찰조반류질음식시간、술후주원시간명현단우대조조[(171.1±45.3)h비(235.8±89.5)h、(11.4±1.8)d비(14.7±4.9)d],차이유통계학의의(P＜0.05);량조배기시간、배편시간、류질음식시간비교차이균무통계학의의(P＞0.05).량조술후병발증발생솔비교차이무통계학의의(P＞ 0.05).결론 상대우CVP감측,위장도수술중급여목표도향액체치료가이명현감소위수술기수액량,축단술후주원시간.
Objective To explore the influence of fluid management and prognosis guided by goal direction on patients undergoing gastrointestinal surgery.Methods Eighty ASA grade Ⅰ-Ⅲ,consecutive consenting patients undergoing gastrointestinal surgery were divided into observation group (40 patients)and control group (40 patients) by random digits table method.The intraoperative fluid management in control group was based on central venous pressure(CVP),and kept CVP at 8-10 mmHg(1 mmHg =0.133 kPa).The intraoperative fluid management in observation group was based on stroke volume variation (SVV),and kept SVV at 10 ％-12％.The operation time,intraoperative and postoperative 3 d fluid management,time of defecation and exhaust,time of full or semi-liquid diet,length of stay in hospital,rate of complications after operation for 48 h between two groups were compared.Results The volume of total fluid,colloid solution and crystalloid solution received during operation in observation group were significantly lower than those in control group[(2 686.0 ± 977.5) ml vs.(4 837.5 ± 1 566.0) ml,(792.4 ± 197.6) ml vs.(1 284.6 ± 356.7)ml,(1 894.9 ± 460.4) ml vs.(3 569.9 ± 1 318.7) ml] (P ＜ 0.05).The time of semi-liquid diet,length of stay in hospital in observation group were significantly lower than those in control group [(171.1 ± 45.3) h vs.(235.8 ±89.5) h,(11.4 ±1.8) d vs.(14.7 ±4.9) d] (P＜0.05).The time of full liquid diet,time of defecation and exhaust between two groups had no significant difference(P ＞ 0.05).The rate of complications between two groups had no significant difference(P ＞ 0.05).Conclusion Compared with monitoring CVP,the fluid management based on SVV can decrease the fluid volume during operation and shorten the length of stay in hospital.
