不同BIS值对每搏变异度指导补液的老年结肠癌根治术患者应激反应的影响

发布时间：2018-01-18 08:05

本文关键词：不同BIS值对每搏变异度指导补液的老年结肠癌根治术患者应激反应的影响　出处：《广东医学》2017年18期 　论文类型：期刊论文

【摘要】：目的探讨在每搏变异度(SVV)指导补液的老年结肠癌根治术中,不同BIS值对患者应激反应的影响。方法将60例静吸复合麻醉下行结肠癌根治术的老年患者随机分为两组(每组n=30):L组(BIS值50~59),D组(BIS值40~49)。术中按晶胶比为2∶1补液,使SVV维持在8~12。记录患者在入室后20 min(T0)、插管后即刻(T1)、手术开始(T2)、手术开始后60 min(T3)、手术开始后120 min(T4)、手术结束(T5)、拔管后30 min(T6)的心率(HR)、平均动脉压(MAP)的值和心输出量(CO)、每搏量(SV)及SVV在T1、T2、T3、T4、T5时点的值。记录术中补液量及血流动力学波动情况。检测患者T0、T4、T6时点血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、血糖(Glu)水平。结果与T0相比,L组患者HR在T4~T6明显增加(P0.05,P0.01),MAP在T1、T2显著下降(P0.05),在T4~T6增加(P0.05,P0.01);D组HR各时点无显著变化,MAP在T1~T5下降(P0.05,P0.01);同时L组HR在T4~T6明显高于D组(P0.05),MAP在T3~T6高于D组(P0.05)。D组术中补液量多于L组(P0.05),高血压发生率低于L组(P0.05)。两组患者Cor、ACTH、Glu在T4、T6均显著升高(P0.05,P0.01);L组患者Cor在T4、T6明显高于D组(P0.05)。结论在SVV指导补液的老年结肠癌根治术中患者麻醉深度维持在BIS值40~49能较好地抑制机体的应激反应,更有利于维持血流动力学的稳定。
[Abstract]:Objective to investigate the effect of SVV on the radical resection of colon cancer in the elderly. Effects of different BIS values on stress response of patients. Methods 60 elderly patients undergoing radical resection of colon cancer were randomly divided into two groups (n = 30: l, n = 30: L, n = 50, n = 59). . The BIS value of group D was 4049.Intraoperative fluid rehydration was 2: 1 according to the ratio of crystal to glue, so that SVV was maintained at 812.Twenty minutes after entering the room, the patients were recorded and the patients were treated with T1 immediately after intubation. The operation began with T2P, 60 min after operation, 120 min after operation, and 120 min after operation, and the end of operation was T5). At 30 min after extubation, the heart rate and mean arterial pressure (MAPP) and cardiac output (SVV) and SVV were measured at T _ (1) T _ (2) and T _ (3) and T _ (4) in T _ (1) T _ (2) and T _ (3) T _ (4). The changes of fluid volume and hemodynamics during operation were recorded. The serum cortisol Corn and ACTH were measured at T0 / T4 and T6 time points. Results compared with T0, HR in T4 / T6 group increased significantly (P 0.05) and map decreased significantly in T _ (1) T _ (2) (P _ (0.05)). In T4, T6, P0. 05 and P0. 01; In group D, there was no significant change in HR at each time point. Map was decreased in T1, T5, P0.05 and P0.01a. At the same time, HR in group L was significantly higher than that in group D (P 0. 05) and map in group T 3 was higher than that in group D (P 0. 05 and P 0. 05). The volume of fluid rehydration in group D was higher than that in group D (P 0. 05). The incidence of hypertension was lower than that of L group (P 0.05). Cor in group L was T4. T6 was significantly higher than that in group D (P0.050.Conclusion maintenance of anesthesia depth at BIS value of 400.49 in SVV guided radical resection of colon cancer in elderly patients with fluid replacement can effectively inhibit the stress response of the body. [WT5 "HZ] [WT5" BZ] [WT5 "BZ]. More conducive to maintaining hemodynamic stability.
【作者单位】：华北理工大学附属医院麻醉科;华北理工大学附属医院妇产科;
【基金】：河北省政府资助临床医学优秀人才培养和基础课题研究项目(编号:361036) 河北省医学科学研究重点课题计划项目(编号:20160740,20170200)
【分类号】：R614;R735.35
【正文快照】： 结肠癌根治手术因操作较复杂、手术范围大以及麻醉和疼痛等因素易导致机体产生强烈的应激反应,增加老年患者围术期心脑血管并发症的风险。麻醉方式及药物的选择可有效减轻机体应激水平,而老年患者全麻下的最适麻醉深度尚无统一认定[1]。每搏变异度(SVV)指导术中补液可有效降低

【相似文献】