脉搏灌注变异指数指导神经外科开颅手术容量管理的临床研究

发布时间：2018-02-28 13:06

本文关键词： 脉搏灌注变异指数目标导向液体治疗开颅手术　出处：《安徽医科大学学报》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨脉搏灌注变异指数(PVI)目标导向液体治疗在神经外科开颅手术患者的临床应用价值。方法 76例择期行开颅手术患者随机分为PVI指导补液组(n=38)和对照组(n=38)。诱导期两组均静脉输注乳酸钠林格6~8ml/kg,维持期PVI指导补液组背景输注乳酸钠林格2 ml/(kg·h),当PVI值连续5 min以上高于14%,快速输注3ml/kg羟乙基淀粉氯化钠(6%HES);对照组背景输注乳酸钠林格4~6 ml/(kg·h),当MAP8.67 k Pa快速输注100~250 ml 6%HES。记录术中液体输入总量、晶体量、胶体量、尿量、出血量、手术时间、麻醉时间;于诱导前(T_0)、手术前(T_1),剥除肿瘤时(T_2)、术毕(T_3)采集动脉血测血气分析值;于术后第1、2、3、7、30天分别随访并发症发生率及恢复情况。结果两组一般资料比较差异无统计学意义;与对照组比较,PVI指导补液组液体总输入量和晶体液输入量减少,胶体液输入量增加(P0.05);两组血气分析值(Lac、pH、Glu、BE)各时间点比较差异无统计学意义。与对照组比较,PVI指导补液组术后并发症颜面部肿胀发生率减少,术后排便时间和术后住院时间缩短(P0.05)。结论 PVI目标导向液体治疗用于神经外科开颅手术能优化术中输液,降低术后水肿并发症的发生率,促进患者恢复。
[Abstract]:Objective to evaluate the clinical value of targeted fluid therapy with pulse perfusion variability index (PVI) in patients undergoing craniotomy in neurosurgery. Methods 76 patients undergoing elective craniotomy were randomly divided into two groups: PVI guided fluid replacement group (PVI) and control group (n = 38). During induction period, both groups were given intravenous infusion of sodium lactate, Ringer (6ml / kg), PVI during maintenance period, background infusion of sodium lactate (2 ml/(kg 路hg), and rapid infusion of 3ml / kg hydroxyethyl starch sodium chloride (3ml / kg) to control group (control group), when PVI value was more than 5 min above 14 min. Sodium Ringer (6 ml/(kg 路hg). When MAP8.67 KPA was infused quickly with 100ml of 250ml and 6hes, the total volume of fluid input during operation was recorded. The volume of crystal, colloid, urine, blood loss, operation time, anesthesia time, before induction, before operation, before operation, T _ 1, T _ 2, T _ 2T _ 2, T _ (3)) were collected. The incidence of complications and recovery were observed at 730 days after operation. Results there was no significant difference in general data between the two groups, and the total fluid input and crystal fluid input were decreased in the PVI guided rehydration group compared with the control group. There was no significant difference between the two groups in the blood gas analysis value and the pH value of Lactein Glube. Compared with the control group, the incidence of postoperative complications of facial swelling in the PVI guided fluid replacement group was decreased, and there was no significant difference between the two groups in blood gas analysis. Conclusion PVI targeted fluid therapy for neurosurgical craniotomy can optimize the intraoperative infusion, reduce the incidence of postoperative edema complications and promote the recovery of patients.
【作者单位】：安徽医科大学第一附属医院麻醉科;
【基金】：卫生部公益性行业科研专项基金项目(编号:3101005002154)
【分类号】：R614

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