CAJ | 학술논문

目的探讨经食道超声多普勒对腹部大手术中液体治疗的价值.方法 96例择期腹部大手术患者,随机分成经食道超声多普勒指导输液组(ODM组,n=49)和对照组(C组,n=47).比较两组液体量、尿量、平均动脉压、心率、入ICU时动脉血乳酸、B型利钠肽及术后7d并发症.结果 ODM组术中输液总量[(5651.5 ±561.8) ml比(5423.8±542.3)ml,P＜0.05]、尿量[(376.5±99.6) ml比(228.9±68.2) ml,P＜0.01]明显增加.手术结束时ODM组平均动脉压[(80.3±8.2) mm Hg(1 mm Hg =0.133 kPa)比(70.0±5.1)mm Hg,P＜0.01]明显高于对照组,两组间心率差异无统计学意义(P＞0.05).术后入ICU时,ODM组乳酸[(1.9±0.3)mmol/L比(3.8±1.1) mmol/L,P＜0.01]显著低于C组,而B型利钠肽[(84.9±17.2) ng/L比(81.2±10.9) ng/L,P＞0.05]两组间差异无统计学意义(P＞0.05).术后并发症两组间差异有统计学意义(P＜0.05).结论经食道超声多普勒指导术中液体治疗可改善组织氧供,降低术后并发症.
목적 탐토경식도초성다보륵대복부대수술중액체치료적개치.방법 96례택기복부대수술환자,수궤분성경식도초성다보륵지도수액조(ODM조,n=49)화대조조(C조,n=47).비교량조액체량、뇨량、평균동맥압、심솔、입ICU시동맥혈유산、B형리납태급술후7d병발증.결과 ODM조술중수액총량[(5651.5 ±561.8) ml비(5423.8±542.3)ml,P＜0.05]、뇨량[(376.5±99.6) ml비(228.9±68.2) ml,P＜0.01]명현증가.수술결속시ODM조평균동맥압[(80.3±8.2) mm Hg(1 mm Hg =0.133 kPa)비(70.0±5.1)mm Hg,P＜0.01]명현고우대조조,량조간심솔차이무통계학의의(P＞0.05).술후입ICU시,ODM조유산[(1.9±0.3)mmol/L비(3.8±1.1) mmol/L,P＜0.01]현저저우C조,이B형리납태[(84.9±17.2) ng/L비(81.2±10.9) ng/L,P＞0.05]량조간차이무통계학의의(P＞0.05).술후병발증량조간차이유통계학의의(P＜0.05).결론 경식도초성다보륵지도술중액체치료가개선조직양공,강저술후병발증.
Objective To investigate the significance of transesophageal Doppler monitoring for fluid therapy in patients undergoing major abdominal surgery.Methods Ninety-six patients undergoing major abdominal surgery were randomly assigned into transesophageal Doppler monitoring group (ODM group,n =49) and control group (C group,n =47).Fluid volume,urine volume,mean arterial pressure and heart rate,lactic acid and B-type natriuretic peptide at ICU admission and complications 7 days after surgery were compared between two groups.Results Fluid volume [(5651.5 ± 561.8) ml vs.(5423.8 ±542.3) ml,P ＜0.05],urine volume [(376.5 ±99.6) ml vs.(228.9 ±68.2) ml,P ＜0.01] in ODM group significantly increased as compared with control group.At the end of operation,mean arterial pressure [(80.3 ± 8.2) mum Hg (1 mm Hg =0.133 kPa) vs.(70.0 ± 5.1) mm Hg,P ＜ 0.01] was higher in ODM group than that in control group,but no significant difference was found in heart rate between groups (P ＞ 0.05).Lactic acid [(1.9 ± 0.3) mmol/L vs.(3.8 ± 1.1) mmol/L,P ＜ 0.01] at ICU admission was markedly lower in ODM group than that in control group,but BNP showed no significant difference between groups.At 7th day after surgery,incidence of complications was lower in ODM group than that in control group.Conclusion Fluid therapy was guided with ODM,which could improve tissue oxygenation and low complication after surgery.