依据每搏变异指数调控冠心病患者术中的液体管理

发布时间：2019-01-05 12:48

【摘要】：目的探究每搏变异(SVV)用于非体外冠脉搭桥手术(OPCABG)患者的容量管理中,指导输注量与血流动力学及内环境的稳定关系。方法择期行OPCABG患者160例随机分为SVV组(80例,依SVV值变化管理液体容量)与对照组(80例)。5个时间点采集心率(HR)与平均动脉压(MAP),即T0:患者入室时;T1:诱导15 min后;T2:诱导插管后60 min;T3:切皮后5 min;T4:拔管前。术后2、12、24和48 h测血浆白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α、血清皮质醇和C-反应蛋白(CRP)浓度及SVV指数。结果 SVV组SVV在各时间点没有显著性变化,对照组T1~T4时间点明显升高(P0.05)。SVV组MAP在T1~T4增高,对照组T1~T4时间点明显降低(P0.05)。对照组MAP在T1~T4均显著低于SVV组(P0.05)。SVV组HR在T1~T4降低,对照组T1~T4明显升高(P0.05)。两组T1~T4的炎性细胞因子均显著升高,对照组的炎性细胞因子在T1~T4均显著高于SVV组(P0.05)。两组T1~T4皮质醇及CRP浓度均比T0显著升高。对照组的皮质醇和CRP在T1~T4显著降低(P0.05)。对照组皮质醇及CRP在T2~T4均显著高于SVV组(P0.05)。结论 SVV用于OPCABG中患者目标导向液体治疗,对维护平稳的血流动力学,并改善组织灌注和氧供需平衡有效。
[Abstract]:Objective to investigate the stable relationship between infusion volume and hemodynamics and internal environment in patients with (OPCABG) undergoing non-extracorporeal coronary artery bypass grafting (OPCABG). Methods one hundred and sixty patients with elective OPCABG were randomly divided into SVV group (80 cases) and control group (80 cases). Heart rate (HR) and mean arterial pressure (MAP),) were collected at 5 time points. T _ 1: after induction for 15 min and T _ 2: for 60 min;T3: after intubation, 5 min;T4: before extubation. Plasma interleukin-6 IL-10, tumor necrosis factor (TNF)-伪, serum cortisol and C-reactive protein (CRP) and SVV index were measured at 24 and 48 hours after operation. Results there was no significant change in SVV group at each time point, but T1~T4 in control group was significantly increased (P0.05 in). SVV group, MAP in T1~T4 was increased, T1~T4 in control group was significantly decreased (P0.05). MAP in the control group was significantly lower in T1~T4 than in SVV group (P0.05). SVV group HR decreased in T1~T4 control group T1~T4 significantly increased (P0.05). The inflammatory cytokines of T1~T4 in both groups were significantly higher than those in SVV group (P0.05), while the inflammatory cytokines in control group were significantly higher in T1~T4 group than in SVV group (P0.05). The concentrations of T1~T4 cortisol and CRP were significantly higher than that of T 0 in both groups. Cortisol and CRP in the control group were significantly decreased in T1~T4 (P0.05). Cortisol and CRP in the control group were significantly higher in T2~T4 than in SVV group (P0.05). Conclusion SVV is effective in maintaining stable hemodynamics and improving tissue perfusion and oxygen supply and demand balance in patients with OPCABG.
【作者单位】：山西医科大学第一医院心胸外科;山西医科大学第一医院心内科;
【基金】：山西省科技攻关项目(No.20130313016-12)
【分类号】：R614

【相似文献】