中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2015年
8期
1848-1851
,共4页
韩宝义%郭海%叶建荣%王江%郑宏
韓寶義%郭海%葉建榮%王江%鄭宏
한보의%곽해%협건영%왕강%정굉
个体化容量治疗%围术期%非体外循环冠脉搭桥手术%心脏不良事件
箇體化容量治療%圍術期%非體外循環冠脈搭橋手術%心髒不良事件
개체화용량치료%위술기%비체외순배관맥탑교수술%심장불량사건
Individualized treatment capacity%Perioperative%Off-pump coronary artery bypass surgery%Cardiac adverse events
目的 探讨基于经食道超声心动图(TEE)和Violeo/微截流(FloTrac)技术在实施目标导向的容量治疗在非体外循环冠状动脉搭桥术中的应用.方法 纳入81例行择期实施非体外循环冠脉搭桥手术的冠心病患者,随机分为2组:每搏变异度(SVV)结合TEE组41例,对照组40例,实验组患者围术期及ICU 24 h采用目标导向容量治疗,即在SVV、TEE等指标下进行个体化容量治疗;对照组根据传统容量治疗方法.比较围术期及术后3d统计液体补充的种类和量、出血量,乳酸含量,氧含量、住院时间、术后心脏不良事件及并发症的发生率.结果 与对照组比较,实验组患者手术过程中血流动力学更加平稳.手术结束时实验组患者血清乳酸含量[(0.28 ±0.03) mmol/L]明显低于对照组[(2.21 ±0.12) mmol/L,P＜0.05].实验组患者总输液量[(2 912±632) ml和(3 641±723) ml]、晶体使用量均明显少于对照组[(1543±331) ml和(2 334±323) ml],而胶体使用量则明显多于对照组[(1012±221) ml和(797±249) ml,P＜0.05].实验组患者围术期住院时间分别为(17 ±4)和(27±7) d(P＜0.05),ICU停留时间分别为(38±13)h和(54±22) h(P ＜0.05).结论 冠心病患者实施实施非体外循环冠脉搭桥手术期间,目标导向容量治疗可明显减少各类心脏不良事件的发生率,改善术后心脏功能并缩短住院时间,其容量的治疗效应优于常规容量治疗方法.
目的 探討基于經食道超聲心動圖(TEE)和Violeo/微截流(FloTrac)技術在實施目標導嚮的容量治療在非體外循環冠狀動脈搭橋術中的應用.方法 納入81例行擇期實施非體外循環冠脈搭橋手術的冠心病患者,隨機分為2組:每搏變異度(SVV)結閤TEE組41例,對照組40例,實驗組患者圍術期及ICU 24 h採用目標導嚮容量治療,即在SVV、TEE等指標下進行箇體化容量治療;對照組根據傳統容量治療方法.比較圍術期及術後3d統計液體補充的種類和量、齣血量,乳痠含量,氧含量、住院時間、術後心髒不良事件及併髮癥的髮生率.結果 與對照組比較,實驗組患者手術過程中血流動力學更加平穩.手術結束時實驗組患者血清乳痠含量[(0.28 ±0.03) mmol/L]明顯低于對照組[(2.21 ±0.12) mmol/L,P＜0.05].實驗組患者總輸液量[(2 912±632) ml和(3 641±723) ml]、晶體使用量均明顯少于對照組[(1543±331) ml和(2 334±323) ml],而膠體使用量則明顯多于對照組[(1012±221) ml和(797±249) ml,P＜0.05].實驗組患者圍術期住院時間分彆為(17 ±4)和(27±7) d(P＜0.05),ICU停留時間分彆為(38±13)h和(54±22) h(P ＜0.05).結論 冠心病患者實施實施非體外循環冠脈搭橋手術期間,目標導嚮容量治療可明顯減少各類心髒不良事件的髮生率,改善術後心髒功能併縮短住院時間,其容量的治療效應優于常規容量治療方法.
목적 탐토기우경식도초성심동도(TEE)화Violeo/미절류(FloTrac)기술재실시목표도향적용량치료재비체외순배관상동맥탑교술중적응용.방법 납입81례행택기실시비체외순배관맥탑교수술적관심병환자,수궤분위2조:매박변이도(SVV)결합TEE조41례,대조조40례,실험조환자위술기급ICU 24 h채용목표도향용량치료,즉재SVV、TEE등지표하진행개체화용량치료;대조조근거전통용량치료방법.비교위술기급술후3d통계액체보충적충류화량、출혈량,유산함량,양함량、주원시간、술후심장불량사건급병발증적발생솔.결과 여대조조비교,실험조환자수술과정중혈류동역학경가평은.수술결속시실험조환자혈청유산함량[(0.28 ±0.03) mmol/L]명현저우대조조[(2.21 ±0.12) mmol/L,P＜0.05].실험조환자총수액량[(2 912±632) ml화(3 641±723) ml]、정체사용량균명현소우대조조[(1543±331) ml화(2 334±323) ml],이효체사용량칙명현다우대조조[(1012±221) ml화(797±249) ml,P＜0.05].실험조환자위술기주원시간분별위(17 ±4)화(27±7) d(P＜0.05),ICU정류시간분별위(38±13)h화(54±22) h(P ＜0.05).결론 관심병환자실시실시비체외순배관맥탑교수술기간,목표도향용량치료가명현감소각류심장불량사건적발생솔,개선술후심장공능병축단주원시간,기용량적치료효응우우상규용량치료방법.
Objective Evaluate the extracorporeal circulation of coronary artery bypass grafting (OPCABG) intraoperative hemodynamic changes,based on the classics esophagus supersonic and Violeo FloTrac/technical implementation capacity of goal-directed therapy,trying to provide reference for individualized treatment capacity.Methods included 81 names of routine execution of extracorporeal circulation of coronary artery bypass surgery in patients with coronary heart disease,were randomly divided into 2 groups:stroke volume variation (SVV),transesophageal echocardiography (TEE) group 41 cases,40 cases in the control group,experimental group patients and perioperative treatment with ICU24h goal-directed capacity,namely the SVV stroke variation degree,individualized treatment capacity under TEE index;Control the amount of fluids is calculated according to the traditional law of 4/2/1.Comparison of perioperative and postoperative 3 days statistical amount and type of liquid supplement,blood loss,and urine output,lactic acid content,oxygen content,record the extubation time,ICU stay time,length of hospital stay,postoperative cardiac adverse events and the inciden.Results Compared with control group,test group patients in the operation process,more stable blood stream dynamics.At the end of operation in the test group serum lactic acid content was lower than that of control group [(0.28 ± 0.03) mmol/L vs.(2.21 ±0.12) mmol/L),P ＜ 0.05].In the test group total infusion volume [(2 912 ± 632) ml vs.(3 641 ±723) ml],the use of crystal were significantly less than the control group [(1 543 ± 331) ml vs.(2 334 ±323) ml],and the colloid use amount is much more than that in control group [(1 012 ± 221) ml vs.(797 ± 249) ml,P ＜ 0.05].The test group patients hospital stay and ICU stay were lower than the control group [(17 ± 4) d vs.(27 ± 7) d,P ＜ 0.05,(38 ± 13) h vs.(54 ± 22) h,P ＞ 0.05].Conclusion The patients with coronary heart disease (CHD) implementation of the implementation of extracorporeal circulation during coronary artery bypass graft surgery,capacity of goal-directed therapy can obviously reduce the incidence of all kinds of adverse cardiac events,improve heart function and shorten the length of hospital stay,postoperative treatment effect of its capacity is superior to the conventional treatment capacity.
