Objective To observe the effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation (rSO 2 )in the elder patient undergoing one-lung ventilation. Methods Fifty-eight patients scheduled for esophagus cancer resection(44 males,14 females,aged 65-79 years,ASA physical status Ⅱ or Ⅲ),were randomly divided into two groups (n =29 each)u-sing a random number table:conventional fluid therapy group (group C)and goal-directed fluid ther-apy group (group G).Implementing radial artery puncture and internal jugular vein puncture under local anesthesia in order to monitor BP and CVP.The Flotrac/Vigileo system was used to monitor cardiac output (CO),stroke volume variation (SVV)and cardiac index (CI)in the both group.As mentioned all above,group C received conventional fluid therapy based on MAP,CVP and urine vol-ume,whereas group G received goal-directed fluid therapy (GDFT)based on SVV with the goal of CI at 2.5-4.0 L·min-1·m-2 .Intraoperative continuous monitoring of rSO 2 was performed and the sur-gery rSO 2 average (rSO 2 ),the minimal surgery rSO 2 (rSO 2min )and the maximal percentage of the decreased rSO 2 compared to baseline values (rSO 2%max )were calculated in the both group.The varia-tion of MAP,HR,CVP,SVV and CI at the onset of the monitoring (T1 ),the momment before one-lung ventilation (T2 ),30 min after one-lung ventilation (T3 ),1 h after one-lung ventilation(T4 )and the end of the surgery (T5 )were recorded.The requirement for crystalloid and colloid,total volume of fluid infused,bleeding volume,urine volume,and requirement for vasoactive agents were recorded during operaton.Results Compared with group C,MAP at T3 ,T4 and CI at T3-T5 in group G were increased significantly,while CVP at T3-T5 and SVV at T2-T5 in group G were decreased (P <0.05). The rSO 2%max in group G was significantly lower than that in group C (P <0.05).No statistically sig-nificant difference was observed in the rSO 2 and rSO 2min between the two groups.Compared with group C,the requirement for crystalloid [(668±187)ml vs (1052±221)ml and total volume of fluid infused [(1212±318)ml vs (1519±329)ml],urine volume [(211±47)ml vs (278±54)ml]and vasoactive agents [4 cases (14%)vs 14 cases (48%)]were significantly decreased (P <0.05),the requirement for colloid were increased [(544±103)ml vs (467±94)ml,P <0.05].Conclusion The goal-directed fluid therapy based on SVV stabilizes the hemodynamic effectively,improves the CI and the perfusion of brain,and maintains the cereral oxygen metabolism in the elder patient undergoing one-lung ventilation.%目的 观察目标导向液体治疗(goal-directed fluid therapy,GDFT)对老年单肺通气患者局部脑氧饱和度(rSO 2)及血流动力学的影响.方法 选择择期全麻下行中段食管癌根治术患者58例,男44例,女14例,年龄65~79岁,ASAⅡ或Ⅲ级,采用随机数字表法分为两组:传统液体治疗组(C组)和GDFT组(G组),每组29例.所有患者均通过桡动脉连接FloTrac/Vigileo监测系统连续监测MAP、心输出量(CO)、心脏指数(CI)和每搏量变异度(SVV).C组根据MAP、CVP及尿量行传统液体疗法;G组于SVV指导下行GDFT,维持CI 2.5~4.0 L·min-1·m-2.所有患者于术中持续监测rSO 2,计算术中rSO 2平均值(rSO 2)、术中rSO 2最小值(rSO 2min)以及rSO 2较基础值下降的最大百分比(rSO 2%max);记录入室建立监测后(T1)、单肺通气前(T2)、单肺通气30 min(T3)、单肺通气1 h(T4)及术毕(T5)时的MAP、HR、CVP、CI及SVV;记录术中晶体液和胶体液用量、总输液量、出血量、尿量以及血管活性药物的使用情况.结果 与C组比较,T3、T4时G组MAP明显升高(P<0.05);T3~T5时G组CVP明显下降、CI明显升高(P<0.05);T2~T5时G组SVV明显下降(P<0.05).G组rSO 2%max明显低于C组(P<0.05),两组rSO 2和rSO 2min差异无统计学意义.与C组比较,G组术中晶体液用量[(668±187)ml vs(1052±221)ml]、总输液量[(1212±318)ml vs(1519±329)ml]、尿量[(211±47)ml vs(278±54)ml]及血管活性药物使用[4例(14%)vs 14例(48%)]明显减少(P<0.05),胶体液用量明显增加[(544±103)ml vs(467±94)ml,P<0.05].结论 基于SVV的GDFT可稳定老年患者单肺通气时的血流动力学,维持脑氧供需稳定.
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