CAJ | 학술논문

目的比较中心静脉氧饱和度(ScvO2)和中心静脉-动脉二氧化碳分压差(P(cv-a)CO2)指导的液体治疗对开腹胃肠道手术患者的影响.方法 2012年6月至2013年4月期间在浙江大学医学院附属第一医院麻醉科行择期开腹胃肠道手术且美国医师协会(ASA)分级Ⅰ-Ⅱ级患者40例,经医院伦理委员会通过,采用随机数字表法随机分为ScvO2指导输液组(S组)及P(cv-a) CO2指导输液组(P组),每组20例.所有患者术前禁食12h、禁水4h,麻醉诱导前给予乳酸林格氏液10 ml/kg,术中乳酸林格氏液2 ml · kg-1·h-1持续静滴,并根据ScvO2和P(cv-a) CO2输注人工胶体(free flex 6％HES 130/0.4),S组患者ScvO2 ＜75％或P组患者P(cv-a) CO2≥6 mm Hg(1 mm Hg=0.133 kPa)时给予6％ HES 130/0.4.手术开始切皮后每20 min进行血气分析,检测患者动静脉血乳酸水平评价组织灌注情况,并记录术后首次肛门排气时间、28 d的并发症发生率和死亡率.结果两组患者术中T4时间点(手术开始后80 min)和T5时间点(手术开始后100 min)的血乳酸值差异有统计学意义(P值分别为0.013和0.044),其他时间点的动、静脉血血乳酸值差异无统计学意义(P＞0.05).患者术后首次肛门排气时间差异无统计学意义(P =0.673),两组患者都未发生明显并发症和死亡.结论开腹胃肠道手术中,与ScvO2指导输液相比,P(cv-a) CO2指导的输液治疗对组织灌注有一过性的提高,但是,两者对患者胃肠道功能恢复及预后的影响无明显临床差异.
목적 비교중심정맥양포화도(ScvO2)화중심정맥-동맥이양화탄분압차(P(cv-a)CO2)지도적액체치료대개복위장도수술환자적영향.방법 2012년6월지2013년4월기간재절강대학의학원부속제일의원마취과행택기개복위장도수술차미국의사협회(ASA)분급Ⅰ-Ⅱ급환자40례,경의원윤리위원회통과,채용수궤수자표법수궤분위ScvO2지도수액조(S조)급P(cv-a) CO2지도수액조(P조),매조20례.소유환자술전금식12h、금수4h,마취유도전급여유산림격씨액10 ml/kg,술중유산림격씨액2 ml · kg-1·h-1지속정적,병근거ScvO2화P(cv-a) CO2수주인공효체(free flex 6％HES 130/0.4),S조환자ScvO2 ＜75％혹P조환자P(cv-a) CO2≥6 mm Hg(1 mm Hg=0.133 kPa)시급여6％ HES 130/0.4.수술개시절피후매20 min진행혈기분석,검측환자동정맥혈유산수평평개조직관주정황,병기록술후수차항문배기시간、28 d적병발증발생솔화사망솔.결과 량조환자술중T4시간점(수술개시후80 min)화T5시간점(수술개시후100 min)적혈유산치차이유통계학의의(P치분별위0.013화0.044),기타시간점적동、정맥혈혈유산치차이무통계학의의(P＞0.05).환자술후수차항문배기시간차이무통계학의의(P =0.673),량조환자도미발생명현병발증화사망.결론 개복위장도수술중,여ScvO2지도수액상비,P(cv-a) CO2지도적수액치료대조직관주유일과성적제고,단시,량자대환자위장도공능회복급예후적영향무명현림상차이.
Objective To investigate the effect of central venous blood oxygen saturation (ScvO2) and venous-arterial PCO2 (P (cv-a)CO2)guided fluid therapy on tissue perfusion,gastrointestinal function recovering and outcome of the patients who undergoing open gastrointestinal surgery.Methods Forty patients undergoing open gastrointestinal surgery were randomly divided into 2 groups (n =20 each):ScvO2 guided fluid therapy (group S) and P (cv-a) CO2 guided fluid therapy (group P).All the patients were infused 10 ml/kg lactated Ringer's (LR) solution before anesthesia induction,they were all also given a continuous lactated Ringer's (LR) solution's infusion at the speed of 2 ml · kg-1 · h-1 during the operation.While,6％ HES 130/0.4 (free flex 6％ HES 130/0.4,Fresenius Kabi) infusion was different between the 2 groups,when the patients of group S' s central venous blood oxygen saturation ＜ 75％ or venous-arterial PCO2 in the patients of P group ≥6 mm Hg,then infused 6％ HES 130/0.4.Arterial and central venous blood gas analyses were performed every 20 minutes after skin incision,measure the venous and arterial lactate value,and record the anal exhaust time after surgery,postoperative complications and mortality in 28 days.Results Compared with group S,the arterial lactate value in T4 (after operation began 80 min) were significantly decreased in group P (P =0.013),and venous lactate value in T5 (after operation began 100 min) were also lower (P =0.044),other lactate value were not different (P ＞ 0.05).The anal exhaust time was not different between the two groups (P =0.673).All the patients were survival,and there were no obvious postoperative complications.Conclusion Compared to group S,there was a transient improvement in tissue perfusion in group P,but there were no difference in complications and mortality.