浏览全部资源
扫码关注微信
基于每搏量变异的容量管理策略在梗阻性黄疸患者手术麻醉管理中的应用
Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial
- 第三军医大学学报 2018年40卷第10期 页码：918-922, 933
- 作者机构：
40038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
[ 甯交琳, E-mail: 460439856@qq.com NING Jiaolin, E-mail: 460439856@qq.com
- 基金信息：陆军军医大学(第三军医大学)第一附属医院“军事医学科技创新计划”资助项目(SWH2017JSZD-02)
DOI：10.16016/j.1000-5404.201801033
中图分类号： R331.31;R614;R657.43收稿：2018-01-04，
修回：2018-02-01，
纸质出版：2018-05-30
- 稿件说明：
移动端阅览
黄艰, 杨贞, 高宪, 等. 基于每搏量变异的容量管理策略在梗阻性黄疸患者手术麻醉管理中的应用[J]. 第三军医大学学报, 2018,40(10):918-922, 933.
Jian HUANG, Zhen YANG, Xian GAO, et al. Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial[J]. Journal of Third Military Medical University, 2018, 40(10): 918-922, 933.
黄艰, 杨贞, 高宪, 等. 基于每搏量变异的容量管理策略在梗阻性黄疸患者手术麻醉管理中的应用[J]. 第三军医大学学报, 2018,40(10):918-922, 933. DOI： 10.16016/j.1000-5404.201801033.
Jian HUANG, Zhen YANG, Xian GAO, et al. Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial[J]. Journal of Third Military Medical University, 2018, 40(10): 918-922, 933. DOI： 10.16016/j.1000-5404.201801033.
摘要
目的
2
探讨基于每搏量变异(stroke volume variance，SVV)为导向的容量管理策略对梗阻性黄疸患者围术期麻醉管理临床应用价值。
方法
2
纳入2015年11月至2017年3月我院肝胆外科接受手术治疗的恶性梗阻性黄疸患者50例，其中男性41例，女性9例，年龄(53.3±8.5)岁，体质量(59.8±9.0)kg，随机分为对照组和SVV组(
n
=25)。两组患者采用相同的麻醉诱导与维持方式。对照组根据有创血压、中心静脉压(central venous pressure，CVP)和麻醉医师的经验进行液体输注和血管活性药物使用；SVV组根据FloTrac/Vigileo分析得到的SVV值指导液体输注和血管药物的使用，维持SVV在13%以下。对比分析两组患者术中血流动力学指标、血气分析指标、术中液体及血管活性药物的使用情况、术后肾脏功能、PACU及ICU停留时间。
结果
2
SVV组患者术中血压稳定，手术结束时乳酸水平无明显增高[（2.48±0.26）mmol/L
vs
（1.48±0.89）mmol/L，
P
<
0.05
]
；氧合指数显著高于对照组，氧合异常发生率显著低于对照组（20%
vs
52%，
P
<
0.05）；术中晶体液的使用量显著少于对照组[（1 150±235）mL
vs
（1 981±808）mL，
P
<
0.01
]
，去甲肾上
腺素的使用率高于对照组（72%
vs
44%，
P
<
0.05），多巴酚丁胺的使用率高于对照组（
n
=25，36%
vs
8%，
P
<
0.05），ICU停留时间显著低于对照组[（1.18±0.63）d
vs
（3.38±1.36）d，
P
<
0.01
]
，肾功能异常发生率组间比较差异无统计学意义（
P
>
0.05）。
结论
2
SVV的容量管理策略能优化梗阻性黄疸患者术中循环状态，减少容量过负荷和血管活性药物滥用的潜在危害，改善微循环灌注，降低呼吸系统并发症的发生率及ICU停留时间。
Abstract
Objective
2
To evaluate the clinical effectiveness of stroke volume variation (SVV)-based strategy of volume management in patients undergoing surgeries for malignant obstructive jaundice.
Methods
2
Fifty patients with malignant obstructive jaundice (including 41 male and 9 female patients
mean age 53.3±8.5 years
mean body mass 59.8±9.0 kg) undergoing surgeries in our hospital between November
2015 and March
2017 were enrolled in this trial. A computer-generated randomization sequence (at a 1:1 ratio) was used to randomly assign patients into control group and SVV group (
n
=25). All the patients received induction and maintenance anesthesia following the same protocols. The patients in the control group were given perioperative fluid replacement and vasoactive drugs according to the invasive artery pressure
central venous pressure (CVP) and the experience of anesthesiologists. In SVV group
a target SVV below 13% was maintained and the fluid volume and use of vasoactive drugs were adjusted according to the perioperative SVV value. The intraoperative hemodynamic indexes
blood gas analysis indexes
intraoperative fluid volume
dose of vasoactive drugs used
postoperative renal function
PACU and ICU stay time were compared between the 2 groups.
Results
2
Compared with those in the control group
the patients in SVV group showed a more stable intraoperative blood pressure without significantly increased lactic acid level
at the end of the operation (2.48±0.26
vs
1.48±0.89 mmol/L
P
<
0.05). The PaO
2
/FiO
2
ratio was significantly higher in SVV group
and the incidence of oxygenation abnormalities was significantly lower in SVV group than in the control group (20%
vs
52%
P
<
0.05). Compared with the control group
the SVV group had a significantly less intraoperative fluid volume (1 981±808
vs
1 150±235 mL
P
<
0.05) and higher rates of norepinephrine use (44%
vs
72%
P
<
0.05) and dobutamine use (
n
=25
8%
vs
36%
P
<
0.05). The duration of ICU stay was significantly shorter in SVV group than in the control group (1.18±0.63
vs
3.38±1.36 d
P
<
0.01). The incidence of renal dysfunction was not significantly different between the 2 groups (
P
>
0.05).
Conclusion
2
In patients undergoing surgeries for malignant obstructive jaundice
SVV-based fluid management can optimize the hemodynamic status and thus helps to reduce the incidence of respiratory and renal dysfunction and shorten the duration of ICU stay to improve the patients' prognosis.
关键词
Keywords
references
KUNJAM M. Clinical approach to patients with obstructive jaundice[J]. Tech Vasc Interv Radiol, 2015, 18(4): 197-200. DOI: 10.1053/j.tvir.2015.07.002.
FANG Y, GURUSAMY KS, WANG Q, et al . Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice[J ] . Br J Surg, 2013, 100(12): 1589-1596. DOI: 10.1002/bjs.9260.
MOOLE H, BECHTOLD M, PULI S R.Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review[J].World J Surg Oncol, 2016, 14(1): 182. DOI: 10.1186/s12957-016-0933-2.
XU J Y, CHEN Q H, LIU S Q, et al . The effect of early goal-directed therapy on outcome in adult severe sepsis and septic shock patients: a meta-analysis of randomized clinical trials[J ] .Anesth Analg, 2016, 123(2): 371-381. DOI: 10.1213/ANE.0000000000001278.
LEE J, KIM W H, RYU H G, et al . Stroke volume variation-guided versus central venous pressure-guided low central venous pressure with milrinone dur ing living donor hepatectomy: a randomized double-blinded clinical trial[J ] .Anesth Analg, 2017, 125(2): 423-430. DOI: 10.1213/ANE.0000000000002197.
ZHANG J, CHEN C Q, LEI X Z, et al . Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study[J ] .Clinics (Sao Paulo), 2013, 68(7): 1065-1070. DOI: 10.6061/clinics/2013(07)27.
廖志敏.Flo Trac/Vigileo系统的临床应用进展[J].西部医学, 2017, 29 (2): 284-287. DOI: 10.3969/j.issn.1672-3511.2017.02.034.
LIAO Z M. Progress in clinical application of Flo Trac/Vigileo system[J].Med J West China, 2017, 29 (2): 284-287. DOI: 10.3969/j.issn.1672-3511.2017.02.034.
刘新锋, 潘家华, 刘红明.FloTrac/Vigileo心排量监测仪在心功能不全患者中的应用[J].中国现代医生, 2012, 50 (31): 103-104.
LIU X F, PAN J H, LIU H M. Clinical study of using FloTrac/Vigileo monitor in patients with cardiac dysfunction[J]. China Modern Doctor, 2012, 50(31): 103-104.
孙振涛, 王宁, 孙雪青, 等.基于FloTrac/Vigileo监测不同PEEP值对患者心指数、每搏变异度及氧输送指数的影响[J].天津医药, 2017, 45 (3): 294-296. DOI: 10.11958/20160785.
SUN Z T, WANG N, SUN X Q, et al . The effects of different values of PEEP on heart index, stroke volume variation and oxygen transport index in patients monitored by FloTrac/Vigileo system[J ] . Tianjin Med J, 2017, 45 (3): 294-296. DOI: 10.11958/20160785.
WANG L, YU W F.Obstructive jaundice and perioperative management[J]. Acta Anaesthesiol Taiwan, 2014, 52(1): 22-29. DOI: 10.1016/j.aat.2014.03.002.
KOBAYASHI M, KOH M, IRINODA T, et al . Stroke volume variation as a predictor of intravascular volume depression andpossible hypotension during the early postoperative period after esophagectomy[J ] . Ann Surgoncol, 2009, 16(5): 1371-1377. DOI: 10.1245/s10434-008-0139-0.
孟改革, 方卫平, 张雷, 等.目标导向液体治疗下晶体液与胶体液输注对肝切除术患者组织灌注和术后恢复的影响[J].临床麻醉学杂志, 2017, 33(6): 557-561
MENG G G, FANG W P, ZHANG L, et al .Effects of goal-directed fluid therapy filled with crystalliods or colliods on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy[J ] .J Clin Anesth, 2017, 33 (6): 557-561.
PEARSE R M, HARRISON D A, MACDONALD N, et al . Effect of a perioperative cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review [J ] . JAMA, 2014, 311(21): 2181-2190. DOI: 10.1001/jama.2014.5305.
STENS J, OEBEN J, VAN DUSSELDORP A A, et al .Non-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the Nexfin blood pressure monitor[J ] . J Clin Monit Comput, 2016, 30(5): 587-594. DOI: 10.1007/s10877-015-9759-7.
0
浏览量
0
下载量
0
CSCD
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
