每搏量变异和中心静脉压监测对胃肠道手术患者术中输液量及预后的影响

摘要

目的 比较每搏量变异(SVV)和中心静脉压(CVP)监测对胃肠道手术患者术中输液量及预后的影响.方法 择期行全身麻醉下胃肠道手术患者40例,ASA Ⅰ～Ⅲ级,随机均分为CVP组和SVV组.CVP组,监测CVP指导输液治疗,维持CVP于8～10 mm Hg；SVV组,监测SVV指导输液治疗,维持SVV于10％～12％.术中连续监测HR、SpO2、RR、ECG、PETCO2、IBP.记录术中和术后3d液体输入量,术中失血量、输血量和尿量,记录术后排气、排便时间、全流质饮食时间、半流质饮食时间和住院时间；记录术后48 h内肺部感染等并发症的发生率.结果 术中输液总量和晶/胶体液SVV组明显低于CVP组(P＜0.05)；两组术后全流质饮食时间、排气时间、排便时间、恶心呕吐等并发症的发生率差异无统计学意义；半流质饮食时间、术后住院时间SVV组明显短于CVP 组(P＜0.05).结论 相对于CVP监测,胃肠道手术中患者使用SVV监测输液治疗可以明显减少围术期输液量,缩短住院时间.%Objective To investigate the clinical efficacy and safety of stroke volume variation guided fluid management for patients undergoing gastrointestinal surgery. Methods Forty ASA class Ⅰ-Ⅲ(Consecutive consenting patients undergoing gastrointestinal surgery were randomized to stroke volume variation guided (group SVV) and central venous pressure (CVP)-based (conventional) intraoperative fluid management (group CVP). The group SW patients followed a dynamic stroke volume variation guided fluid protocol maintaining SW at 10%-12% whereas group CVP patients were managed using routine cardiovascular monitoring aiming for a CVP between 8 and 10 mm Hg. HR,SpO2 ,RR,ECG,PetCO2 and IBP were monitored during operatioa The liquid and blood input, blood loss,time of full or semi-liquid diet,time of defecation and exhaust,rate of complications at 48 h of postoperation such as pulmonary infection and length of stay were recored. Results The volume of fluid and crystalloid/colloid solution received during operation in group SW was significantly lower than those in group CVP (P<0. 05). The median time to resuming semi-liquid diet and the median postoperative stay in group SW was obviously shorter than those in group CVP (P<0. 05). There is no difference between the two groups on the full liquid diet time, exhaust time, defecation time, incidence of complications such as nausea and vomiting during postoperation period. Conclusion Compared with CVP-based intraoperative fluid management, intraoperative stroke volume variation guided fluid management decreases the fluid volume during operation and the hospital stay.