脉搏灌注变异指数指导神经外科开颅手术患者容量管理的临床研究

发布时间：2018-06-15 04:12

本文选题：脉搏灌注变异指数 + 目标导向液体治疗　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的探讨脉搏灌注变异指数(PVI)指导的容量管理在神经外科肿瘤患者开颅手术患者的临床应用价值。方法选择择期行开颅手术患者76例,随机分为PVI指导补液组(PVI组,n=38)和对照组(CON组,n=38)。诱导期两组均静脉输注乳酸钠林格6~8 ml?kg-1,维持期PVI组输注乳酸钠林格2 ml?kg-1?h-1,当PVI值连续5 min以上高于14%,快速输注3 ml?kg-1羟乙基淀粉氯化钠(6%HES);CON组输注乳酸钠林格4~6ml?kg-1?h-1,当MAP65 mm Hg,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(T0)、手术前(T1),切除肿瘤时(T2)、术毕(T3)采集动脉血行血气分析;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(P0.05);与CON组比较,PVI组液体总输入量减少、晶体液输入量减少、胶体液输入量增加(P0.05);两组患者血气分析值(Lac、p H、Glu、BE)各时间点比较差异无统计学意义(P0.05。与CON组比较,PVI组术后并发症颜面部肿胀发生率减少(P0.05);术后排便时间和术后住院时间缩短(P0.05)。结论1,PVI指导的目标导向液体治疗用于神经外科开颅手术能减少术中输液总量,优化术中输液。2,PVI指导的目标导向液体治疗用于神经外科开颅手术能降低术后水肿相关并发症的发生率;促进患者恢复。
[Abstract]:Objective to investigate the clinical value of volume management guided by PVI in patients with neurosurgical tumors undergoing craniotomy. Methods 76 patients undergoing elective craniotomy were randomly divided into two groups: PVI group (PVI group) and control group (Con group). During induction period, both groups were given intravenous infusion of sodium lactate, Ringer, 8 ml / kg -1, and maintenance group, sodium lactate, Ringer, 2 ml / kg -1 h -1, respectively. When the value of PVI was higher than 14 min in a row, rapid infusion of 3 ml?kg-1 hydroxyethyl starch sodium chloride 6HESCON group was infused with Ringer lactate 6 ml / kg -1 h-1, when MAP65 mm. HG, quick infusion of 100ml, 250ml, 6HES5. The total volume of fluid input, crystal volume, colloid quantity, urine volume, blood loss, operation time and anesthesia time were recorded during the operation, and arterial blood gas was collected before induction, before operation, at the time of resection of tumor, after operation, arterial blood was collected for blood gas analysis. The complication rate and recovery were followed up at 730 days after operation. Results there was no significant difference in general data between the two groups (P 0.05), but the total liquid input and crystal liquid input in the PVI group were decreased compared with those in the Con group. There was no significant difference in blood gas analysis between the two groups (P 0.05). Compared with the Con group, the postoperative complications of PVI group decreased the incidence of facial swelling and shortened the postoperative defecation time and postoperative hospitalization time. Conclusion (1) the target oriented fluid therapy guided by PVI can reduce the amount of fluid infusion in neurosurgical craniotomy. Optimizing the target oriented fluid therapy guided by intraoperative infusion of PVI for neurosurgery craniotomy can reduce the incidence of postoperative edema related complications and promote the recovery of patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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