目标导向液体治疗在择期神经外科手术中对颅内压和脑氧供需平衡的影响

发布时间：2018-02-14 00:30

本文关键词： 目标导向液体治疗颅内压脑氧供需平衡择期颅脑手术　出处：《华中科技大学学报(医学版)》2015年01期 　论文类型：期刊论文

【摘要】：目的观察目标导向液体治疗在择期神经外科手术中对颅内压和脑氧供需平衡的影响。方法选择择期全麻下行开颅肿瘤切除术的患者24例,随机分为2组:常规输液组(C组,n=12)和目标导向液体治疗组(G组,n=12)。C组按经典输液方案进行术中液体管理;G组在Flortrac/Vigileo系统监测下,以每搏量变异度(SVV)为导向行液体治疗。分别于麻醉诱导前(T1)、气管插管即刻(T2)、切开硬脑膜时(T3)、切开硬脑膜后1h(T4)、术毕(T5)记录平均动脉压(MAP)、心率(HR)、心输出量指数(CI)、颅内压(ICP)、SVV、颈静脉球血氧饱和度(SjvO2),并计算脑氧摄取率(CERO2),同时记录手术时间、晶体液量、胶体液量、输血量、尿量及出血量。结果与C组比较,G组患者尿量、术中胶体液量及液体总量均增加(均P0.05)。T4、T5时点G组的MAP、CI均高于C组,且SjvO2增高、CERO2下降(均P0.05)。与C组比较,G组ICP各时点差异无统计学意义(P0.05)。结论目标导向液体治疗能够优化心脏前负荷,不增加颅内压,改善脑氧供需平衡。
[Abstract]:Objective to observe the effect of goal-oriented fluid therapy on intracranial pressure and cerebral oxygen supply and demand balance during selective neurosurgery. Methods 24 patients undergoing craniotomy under elective general anesthesia were selected. They were randomly divided into two groups: routine infusion group (group C) and target oriented liquid therapy group (group G). Group G was monitored by Flortrac/Vigileo system according to the classical infusion protocol. Before induction of anesthesia, T1, T2, T3, T4, T5) were recorded before anesthesia induction, heart rate HRR, cardiac output index (CI). The blood oxygen saturation of jugular bulb and SjvO _ 2 were used to calculate the cerebral oxygen uptake rate and to record the operation time. Results compared with group C, the volume of urine, the amount of colloid fluid and the total amount of fluid in group G were increased (all P0.05T4T5 and MAPCI were higher in group G than in group C). Compared with group C, there was no significant difference in ICP between group C and group C (P 0.05). Conclusion Goal-oriented fluid therapy can optimize cardiac preload, do not increase intracranial pressure, and improve the balance of cerebral oxygen supply and demand.
【作者单位】：武汉科技大学附属医院麻醉科;华中科技大学同济医学院附属协和医院麻醉科;
【基金】：湖北省自然科学基金资助项目(No.2012FFB04905)
【分类号】：R614

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