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目标导向液体疗法对胃肠道手术患者心脏功能的影响

发布时间:2018-01-07 08:19

  本文关键词:目标导向液体疗法对胃肠道手术患者心脏功能的影响 出处:《华北理工大学》2016年硕士论文 论文类型:学位论文


  更多相关文章: 目标导向液体疗法 胃肠道手术 心脏功能 心房利钠肽(ANP) 心肌肌钙蛋白I(cTnI)


【摘要】:目的观察目标导向液体疗法对胃肠道手术患者围术期心脏功能的影响。方法选取60例择期行胃肠道手术的患者,美国麻醉医师学会(ASA)分级Ⅱ-Ⅲ级,将其随机分成两组:实验组(A组)30例,对照组(B组)30例,实验组(A组)根据每搏量变异度(stroke volume variation,SVV),心脏指数(cardiac index,CI),每搏输出量指数(stroke volume index,SVI)进行目标导向液体治疗。对照组(B组)根据中心静脉压(CVP)及平均动脉压(MAP)进行常规液体输注。所有患者入室后连续监测心电图(ECG),心率(HR),平均动脉压(MAP),中心静脉压(CVP),脉搏血氧饱和度(Sp O2),心输出量(cardiac output,CO)。记录手术前(即麻醉前T1)、手术开始(T2)、手术1h(T3)和手术结束(T4)4个时间点的心脏指数(cardiac index,CI),动脉血气,同时对各时间点的心房利钠肽(atrial natriuretic peptide,ANP)及心肌肌钙蛋白I(cardiac troponin I,cTnI)的表达进行测定。结果与B组比较,A组晶体液输液量减少【(966±222)vs(1356±244)ml,P㩳0.05】;但胶体液输入量增多【(1272±189)vs(983±202)ml,P㩳0.05】,尿量增多【(428±54)vs(359±66)ml,P㩳0.05】。A组较B组术中血流动力学更加稳定,A组T2~T4时的MAP与CVP均高于B组(P㩳0.05),A组T2~T4时的CI、SVI、CO均高于B组(P㩳0.05),T2-T4时测得的ANP及cTnI数值实验组(A组)均低于对照组(B组)(P㩳0.05)。结论目标导向液体疗法能够维持血流动力学的稳定,减少围术期心肌的损害,保护患者的心脏功能。
[Abstract]:Objective To observe the effect of targeted liquid therapy on cardiac function during perioperative period in patients with gastrointestinal surgery . Methods 60 patients with gastrointestinal surgery were randomly divided into two groups : experimental group ( group A ) and control group ( group B ) . The control group ( group A ) was randomly divided into two groups : experimental group ( group A ) , heart index ( CI ) and stroke volume index ( SVI ) . All patients were continuously monitored for electrocardiogram ( ECG ) , heart rate ( HR ) , mean arterial pressure ( MAP ) , central venous pressure ( CVP ) , pulse blood oxygen saturation ( Sp O2 ) and cardiac output ( CO ) . The cardiac index ( CI ) , arterial blood gas , atrial natriuretic peptide ( ANP ) and cardiac troponin I ( cardiac troponin I , cardiac troponin I ) were measured before and after operation ( i.e . , T1 before anesthesia ) , beginning of operation ( T2 ) , operation 1h ( T3 ) and end of operation ( T4 ) . Results Compared with group B , the amount of infusion of atrial natriuretic peptide ( ANP ) and cardiac troponin I ( cardiac troponin I ) in group A were significantly decreased ( 966 卤 222 ) vs ( 1356 卤 244 ) ml , P ? 0.05 ) ; however , the volume of colloid fluid increased significantly ( 72 卤 189 ) vs ( 3.98 卤 202 ) ml , P ? 0.05 ) , and the urinary volume increased ( 428 卤 54 ) vs ( 359 卤 66 ) ml , P ? 0.05 ) . In group A , MAP and CVP were more stable in group A than in group B ( P ? 0.05 ) , and the values of CI , SVI and CO in group A were higher than those in group B ( P ? 0.05 ) . Conclusion The target - guided liquid therapy can maintain the stability of hemodynamics , reduce myocardial damage during perioperative period , and protect the heart function of patients .

【学位授予单位】:华北理工大学
【学位级别】:硕士
【学位授予年份】:2016
【分类号】:R614


本文编号:1391737

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