PiCCO监测在PKRP容量管理中的临床应用

发布时间：2018-11-14 09:27

【摘要】：一、目的：研究PiCCO（脉搏指示连续心输出量）监测在PKRP（经尿道等离子前列腺电切术）患者容量监测中的临床意义，从而达到提高患者围术期安全，促进患者顺利康复的目的。二、方法：选择ASAI-II级20例前列腺增生症行PKRP手术患者，分别在手术前（T0)、麻醉诱导后5分钟（T1)、灌注5000ml(T2)时、灌注10000ml(T3)时、灌注15000ml(T4)时、灌注20000ml(T5)时，，通过PiCCO监测CI（心指数）、GEDI(全心舒张末期容积指数)、ITBI(胸腔内血容量指数)、EWLI（血管外肺水指数）；通过多功能监护仪监测HR（心率）、MAP（平均动脉压）、SPO2（氧饱和度）、CVP（中心静脉压）、BIS(脑电双频指数)。三、结果：与手术前相比，患者心输出量、全心舒张末期血容积、胸腔内血容量在麻醉诱导后有显著下降（P0.05），随后逐渐回升。在手术过程中,生理盐水冲洗量20000ml，各时间点心输出量、全心舒张末期血容量、胸腔内血容量与手术初期相比变化无显著差异（P0.05）。四、结论：（1）在PKRP手术中，PiCCO监测中CI、GEDI、ITBI等指标能灵敏、准确地反映患者血流动力学变化，对评估患者容量状态有指导意义。（2）PKRP手术采用0.9%生理盐水做为灌注液，当冲洗量小于20000ml时，对本研究中的患者血流动力学影响较小。
[Abstract]:Objective: to study the clinical significance of PiCCO (pulse indicating continuous cardiac output) monitoring in patients with PKRP (transurethral plasma prostatectomy), so as to improve the perioperative safety of patients. The purpose of promoting the smooth recovery of patients. Methods: twenty patients with ASAI-II grade benign prostatic hyperplasia underwent PKRP operation. Before operation (T0), 5 minutes after anesthesia induction (T1), 5 minutes after anesthesia induction (T1), 5000ml (T2), 10000ml (T3) and 15000ml (T4) were perfused. When 20000ml (T5) was infused, CI was monitored by PiCCO (), GEDI (total diastolic volume index (), ITBI (), intrathoracic blood volume index (), EWLI (), extravascular pulmonary fluid index (), EWLI (). HR (heart rate), MAP (mean arterial pressure) and SPO2 (oxygen saturation), CVP (central venous pressure), BIS (bispectral index) were monitored by multifunctional monitor. Results: compared with before operation, the cardiac output, end-diastolic blood volume and intrathoracic blood volume of patients decreased significantly after anesthesia induction (P0.05), and then increased gradually. During the operation, there was no significant difference in the volume of saline irrigation, the output of dim sum at each time, the end-diastolic blood volume of the whole heart and the blood volume in the thoracic cavity (P0.05). Conclusion: (1) in PKRP operation, the indexes such as CI,GEDI,ITBI in PiCCO monitoring can reflect the hemodynamic changes of the patients accurately and sensitively, and have a guiding significance in evaluating the volume status of the patients. (2) 0.9% normal saline was used as perfusion fluid in PKRP operation. When the amount of irrigation was less than 20000ml, the hemodynamics of the patients in this study was less than that of normal saline.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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