中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
Chinese Journal of Anesthesiology
2015年
8期
987-989
,共3页
雷敏%鲍琪%许浬渊%钟泰迪
雷敏%鮑琪%許浬淵%鐘泰迪
뢰민%포기%허리연%종태적
体积描记术%补液疗法%监测,手术中%胸腔镜检查
體積描記術%補液療法%鑑測,手術中%胸腔鏡檢查
체적묘기술%보액요법%감측,수술중%흉강경검사
Plethysmograp%Fluid therapy%Monitoring,intraoperative%Thoracoscopy
目的 评价脉搏变异指数(PVI)指导胸腔镜手术患者容量治疗的效果.方法 择期胸腔镜肺叶切除术患者40例,性别不限,年龄18～64岁,ASA分级Ⅰ或Ⅱ级,体重指数＜35 kg/m2,采用随机数字表法分为2组(n=20):对照组(C组)和PVI组.C组和PVI组麻醉诱导期快速静脉输注复方电解质注射液250 ml,随后以2～8 ml·kg-1·h-1的速率持续静脉输注.C组以羟乙基淀粉130/0.4氯化钠注射液50 ml和间羟胺0.5 mg维持MAP≥65 mmHg;PVI组以羟乙基淀粉130/0.4氯化钠注射液50 ml和间羟胺0.5 mg维持PVI≤13％和MAP≥65 mmHg.分别于单肺通气开始即刻(T1)、单肺通气结束即刻(T2)和术后1 h(T3)时,记录SpO2,同时采集动脉血样行血气分析,记录乳酸浓度;分别于术前24 h和术后24 h时测定血肌酐浓度.记录术中液体出入量.结果 与C组比较,PVI组术中胶体液输入量、液体总输入量、T3时血乳酸浓度降低(P＜0.05);2组间各时点SpO2和血肌酐浓度、术中晶体液输入量、尿量和出血量差异无统计学意义(P＞0.05).结论 PVI指导下的容量治疗用于胸腔镜手术患者不仅能维持有效的血容量和组织灌注,还能减少术中液体输入量,有利于减轻肺水超负荷.
目的 評價脈搏變異指數(PVI)指導胸腔鏡手術患者容量治療的效果.方法 擇期胸腔鏡肺葉切除術患者40例,性彆不限,年齡18～64歲,ASA分級Ⅰ或Ⅱ級,體重指數＜35 kg/m2,採用隨機數字錶法分為2組(n=20):對照組(C組)和PVI組.C組和PVI組痳醉誘導期快速靜脈輸註複方電解質註射液250 ml,隨後以2～8 ml·kg-1·h-1的速率持續靜脈輸註.C組以羥乙基澱粉130/0.4氯化鈉註射液50 ml和間羥胺0.5 mg維持MAP≥65 mmHg;PVI組以羥乙基澱粉130/0.4氯化鈉註射液50 ml和間羥胺0.5 mg維持PVI≤13％和MAP≥65 mmHg.分彆于單肺通氣開始即刻(T1)、單肺通氣結束即刻(T2)和術後1 h(T3)時,記錄SpO2,同時採集動脈血樣行血氣分析,記錄乳痠濃度;分彆于術前24 h和術後24 h時測定血肌酐濃度.記錄術中液體齣入量.結果 與C組比較,PVI組術中膠體液輸入量、液體總輸入量、T3時血乳痠濃度降低(P＜0.05);2組間各時點SpO2和血肌酐濃度、術中晶體液輸入量、尿量和齣血量差異無統計學意義(P＞0.05).結論 PVI指導下的容量治療用于胸腔鏡手術患者不僅能維持有效的血容量和組織灌註,還能減少術中液體輸入量,有利于減輕肺水超負荷.
목적 평개맥박변이지수(PVI)지도흉강경수술환자용량치료적효과.방법 택기흉강경폐협절제술환자40례,성별불한,년령18～64세,ASA분급Ⅰ혹Ⅱ급,체중지수＜35 kg/m2,채용수궤수자표법분위2조(n=20):대조조(C조)화PVI조.C조화PVI조마취유도기쾌속정맥수주복방전해질주사액250 ml,수후이2～8 ml·kg-1·h-1적속솔지속정맥수주.C조이간을기정분130/0.4록화납주사액50 ml화간간알0.5 mg유지MAP≥65 mmHg;PVI조이간을기정분130/0.4록화납주사액50 ml화간간알0.5 mg유지PVI≤13％화MAP≥65 mmHg.분별우단폐통기개시즉각(T1)、단폐통기결속즉각(T2)화술후1 h(T3)시,기록SpO2,동시채집동맥혈양행혈기분석,기록유산농도;분별우술전24 h화술후24 h시측정혈기항농도.기록술중액체출입량.결과 여C조비교,PVI조술중효체액수입량、액체총수입량、T3시혈유산농도강저(P＜0.05);2조간각시점SpO2화혈기항농도、술중정체액수입량、뇨량화출혈량차이무통계학의의(P＞0.05).결론 PVI지도하적용량치료용우흉강경수술환자불부능유지유효적혈용량화조직관주,환능감소술중액체수입량,유리우감경폐수초부하.
Objective To evaluate the efficacy of pleth variability index (PVI) in guiding volume therapy in the patients undergoing thoracoscopic surgery.Methods Forty patients of both sexes, aged 18-64 yr, with body mass index＜35 kg/m2 , of American Society of Anesthesiologists physical status I or Ⅱ ,scheduled for elective thoracoscopic lobectomy, were randomized into 2 groups (n =20 each) : control group (group C) and PVI group.During induction of anesthesia, multiple electrolyte solution was infused rapidly as a bolus of 250 ml, followed by a 2-8 ml · kg-1 · h-1 infusion.In group C, 6％ hydroxyethyl starch 130/0.4 and sodium chloride injection 50 ml and metaraminol 0.5 mg were administered to maintain mean arterial pressure ≥ 65 mmHg.In group PVI, 6％ hydroxyethyl starch 130/0.4 and sodium chloride injection 50 ml and metaraminol 0.5 mg were administered to maintain PVI ≤ 13％ and mean arterial pressure ≥ 65 mmHg.Immediately after the beginning of one-lung ventilation (T1) , immediately after the termination of one-lung ventilation (T2) and at 1 h after surgery (T3) , arterial oxygen saturation were recorded, and arterial blood samples were collected for blood gas analysis, and for determination of lactic acid concentrations.The blood creatinine concentrations were measured at 24 h before and after surgery.The fulid balance was recorded.Results The amount of colloid solution infused, total volume of fluid infused and lactic acid concentrations at T3were significantly lower in group C than in group PVI.There were no significant differences in the amount of crystralloid solution infused, urine volume, blood loss, arterial oxygen saturation at each time point, and blood creatinine concentrations at 24 h before and after surgery between the two groups.Conclusion PVI-guided volume therapy can not only maintain adequate blood volume and tissue perfusion, but also reduce the amount of fluid infused, and is helpful in mitigating lung water overload when used for the patients undergoing thoracoscopic surgery.
