CAJ | 학술논문

目的探讨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.方法择期行胃肠道肿瘤根治术的患者100例,年龄65 ～ 90岁,性别不限,体重40～ 80 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=50):目标导向液体治疗组(G组)和常规液体治疗组(C组).术中连续监测HR、MAP、CVP、SpO2和PETCO2.G组同时采用FloTrac/Vigileo监测系统监测心输出量(CO)、心脏指数(CI)、每搏量(SV)、每搏量指数(SVI)和每搏量变异度(SVV).C组维持MAP 60～110 mmHg,CVP 6～ 12 cmH2O;G组维持CI 2.5～4.0 L· min-1·m-2,SVV 2％～13％,MAP 65 ～ 110mmHg,SVI 35～47 ml/m2.晶体液为复方电解质液,胶体液为130/0.4羟乙基淀粉溶液.记录术中晶体量和胶体量用量、总输液量、尿量、术中血管活性药物使用情况.记录气管拔管时间、术后首次排气时间、术后住院时间、总住院时间和总医疗费用.记录术后手术相关并发症、术中和术后心血管和肺部并发症、术后少尿、无尿和肾功能不全的发生情况.结果与C组比较,G组术中晶体液用量、胶体液用量、总输液量和尿量减少,血管活性药物使用率升高,术后住院时间、总住院时间和首次排气时间缩短,总医疗费用降低,术后手术相关并发症、肺部并发症及心血管并发症的发生率降低(P＜0.05或0.01).结论基于FloTrac/Vigileo监测系统的目标导向液体治疗可显著促进胃肠道手术老年患者术后康复,具有一定的临床价值.
목적 탐토목표도향액체치료대위장도종류수술노년환자술후강복적영향.방법 택기행위장도종류근치술적환자100례,년령65 ～ 90세,성별불한,체중40～ 80 kg,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법분위2조(n=50):목표도향액체치료조(G조)화상규액체치료조(C조).술중련속감측HR、MAP、CVP、SpO2화PETCO2.G조동시채용FloTrac/Vigileo감측계통감측심수출량(CO)、심장지수(CI)、매박량(SV)、매박량지수(SVI)화매박량변이도(SVV).C조유지MAP 60～110 mmHg,CVP 6～ 12 cmH2O;G조유지CI 2.5～4.0 L· min-1·m-2,SVV 2％～13％,MAP 65 ～ 110mmHg,SVI 35～47 ml/m2.정체액위복방전해질액,효체액위130/0.4간을기정분용액.기록술중정체량화효체량용량、총수액량、뇨량、술중혈관활성약물사용정황.기록기관발관시간、술후수차배기시간、술후주원시간、총주원시간화총의료비용.기록술후수술상관병발증、술중화술후심혈관화폐부병발증、술후소뇨、무뇨화신공능불전적발생정황.결과 여C조비교,G조술중정체액용량、효체액용량、총수액량화뇨량감소,혈관활성약물사용솔승고,술후주원시간、총주원시간화수차배기시간축단,총의료비용강저,술후수술상관병발증、폐부병발증급심혈관병발증적발생솔강저(P＜0.05혹0.01).결론 기우FloTrac/Vigileo감측계통적목표도향액체치료가현저촉진위장도수술노년환자술후강복,구유일정적림상개치.
Objective To investigate the effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing resection of gastrointestinal tumor.Methods A total of 100 elderly patients of both sexes,aged 65-90 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective radical operations for stomach,colon or rectal cancers,were included and randomly divided into 2 groups (n =50each) using a random number table:goal-directed fluid therapy group (group G) and conventional fluid therapy group (group C).HR,mean arterial pressure,central venous pressure,arterial oxygen saturation and partial pressure of end-tidal CO2 were monitored continuously in the two groups.The FloTrac/Vigileo system was used to monitor cardiac output,cardiac index,stroke volume,stroke volume index and stroke volume variation at the same time in group G.In group C,mean arterial pressure was maintained at 60-110 mmHg,and central venous pressure at 6-12 cmH2O.In group G,cardiac index was maintained at 2.5-4.0 L · min-1 · m-2,stroke volume variation at 2％-13％,mean arterial pressure at 65-110 mmHg and stroke volume index at 35-47 ml/m2.Crystalloid solution was compound electrolyte solution,and colloid solution was hydroxyethyl starch 130/0.4.The requirement for crystalloid and colloid,total volume of fluid infused,urine volume,and requirement for vasoactive agents were recorded during operation.The time for removal of the endotracheal tube,time when the patients passed the flatus,length of hospital stay after operation,total length of hospital stay,and total medical costs were recorded.The operation-related complications after operation,and development of cadiovascular and pulmonary complications,oliguria,anuria and renal insufficiency during and after operation were recorded.Results Compared with group C,the requirement for crystalloid and colloid,total volume of fluid infused and urine volume were significantly decreased,the requirement for vasoactive agents was increased,the length of hospital stay after operation,total length of hospital stay and time when the patients passed the flatus were shortened,and total medical costs were reduced,and the incidence of operation-related complications after operation,and cadiovascular and pulmonary complications was decreased in group G.Conclusion Goal-directed fluid therapy based on FloTrac/Vigileo system can significantly promote postoperative rehabilitation and shows certain clinical value in elderly patients undergoing resection of gastrointestinal tumor.