目标导向液体治疗联合肺复张在食管癌根治术患者的应用观察

发布时间：2018-05-15 19:50

本文选题：目标导向液体治疗 + 肺复张　；参考：《河北医学》2016年11期

【摘要】：目的:观察目标导向液体治疗联合肺复张在食管癌根治术患者血流动力学、肺功能和术后肺部并发症的影响。方法:选择2015年6月至2016年5月我院胸外科食管癌切除术的患者50例,采用随机法分为对照组(A组,n=25)和治疗组(B组,n=25)。两组均以胸腔内血容量指数(ITBVI)800~1000m L/m~2为目标导向的液体治疗进行补液,B组同时于单肺通气(OLV)开始前,OLV结束前,关胸前,拔管前以及任何中断通气后应用呼气末正压(PEEP)递增高法进行反复肺复张。应用脉搏指示剂连续心排血(PiCCO)监测仪记录术前(T_0)、双肺通气15min(T_1)、单肺通气15min(T_2)、肺复张后双肺通气15min(T_3)和术毕(T_4)患者的平均动脉压(MAP)、心率、ITBVI。记录两组患者术前(T_0)和术后第2天(T_5)肺功能实验和术后肺部相关并发症发生率。结果:两组患者各时点的MAP、HR、ITBVI比较差异无统计学意义(P0.05),治疗期间无因血流动力学不稳定而终止肺复张的患者。术前肺功能实验比较差异无统计学意(P0.05),术后第2天治疗组的FEV1、FVC、FEV1%FVC均高于对照组差异有统计学意义(P0.05)。治疗组术后低氧血症、肺部感染和延迟拔出气管导管的发生率均低于对照组差异有统计学意义(P0.05)。结论:食管癌切除术中,使用目标导向液体治疗联合肺复张可保证患者血流动力学稳定、促进术后肺功能的恢复并且能够降低术后肺部并发症的发生。
[Abstract]:Aim: to observe the effects of goal-oriented fluid therapy combined with pulmonary retraction on hemodynamics, pulmonary function and postoperative pulmonary complications in patients with esophageal carcinoma undergoing radical resection. Methods: from June 2015 to May 2016, 50 patients with esophageal carcinoma were randomly divided into control group (group A) and treatment group (group B). Both groups were treated with fluid infusion guided by ITBVI (800m L/m~2) in both groups at the same time before the beginning of single lung ventilation (OLVV) and before closing the chest. Repeated lung retentions were performed before extubation and after any interruption of ventilation by means of increasing end-expiratory pressure (PEEP). The mean arterial pressure (MAPMAPand heart rate ITBVI) and heart rate (ITBVI) were recorded by pulse indicator continuous cardiac ejection (PiCCO) monitor before operation. The mean arterial pressure (MAPP) and heart rate (ITBVI) were recorded in patients with T _ 0, T _ (1), T _ (2), T _ (2), T _ (3) and T _ (4). The pulmonary function test and the incidence of postoperative pulmonary complications were recorded in both groups. Results: there was no significant difference in mitogen HRV and ITBVI between the two groups at different time points (P 0.05). There were no patients with pulmonary regurgitation due to hemodynamic instability during the treatment. There was no significant difference in preoperative pulmonary function test (P 0.05). The FEV 1 FV C and FEV 1 FVC in the treatment group were significantly higher than those in the control group on the second day after operation (P 0.05). The incidence of hypoxemia, pulmonary infection and delayed extraction of trachea catheter in the treatment group was significantly lower than that in the control group (P 0.05). Conclusion: in the resection of esophageal carcinoma, the use of goal-oriented fluid therapy combined with Zhang Ke can ensure the hemodynamic stability of the patients, promote the recovery of pulmonary function and reduce the incidence of postoperative pulmonary complications.
【作者单位】：承德医学院附属医院;
【分类号】：R614;R735.1

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