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

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6~8 ml/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3 ml/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MAP14% more than 5 minutes, 3 ml/kg hydroxyethyl starch(6% HES) infused rapidly.Control group infused lactated Ringer′s solution at a rate of 4~6 ml/(kg·h).When MAP less than 8.67 kPa, intermittent infused 100~250 ml hydroxyethyl starch(6% HES) rapidly.The liquid infusion, urine volume, bleeding volume, time of operation, anesthsic time and blood gas analysis were recorded before induction(T0), before surgery(T1), strippingtumor(T2), end of the surgery(T3), respectively.Follow-up the complications and recovery on the first, second, third, seventh and thirtieth postoperative day.Results There were no significance on general monitoring indicators between the two groups.Compared with control group, the crystalloid infusion and the whole transfusion were significantly lower in PVI group, colloidal liquid infusion was significantly higher in PVI group(P<0.05).There were no significantly differences in blood gas analysis(Lac, pH, Glu, BE) at four times between the two groups.Compared with control group, postoperative follow-up facial edema, postoperative defecation time and postoperative hospital stay were significantly lower in PVI group (P<0.05).Conclusion Goal-directed fluid therapy based on PVI can optimize fluid infusion, reduce the incidence of postoperative complications and improve postoperative recovery in patients undergoing craniotomy.