脉搏压变异度指导肺部分切除术液体管理的随机对照分析

摘要

目的 探讨脉搏压变异度(pulse pressure variation,PPV)指导胸腔镜辅助下肺部分切除术病人术中液体管理对氧合指数及短期预后的影响.方法 择期行胸腔镜辅助下肺部分切除术病人52例,随机分为2组:常规补液组(C组)26例,PPV管理补液组(P组)26例,3.0％≤PPV ＜7.0％.C组病人术中根据心率、平均动脉压、尿量指导输液.P组病人根据PPV(3.0％≤PPV ＜7.0％)指导补液.比较两组病人诱导前(T1)、结束单肺通气前5分钟(T2)、术后48小时(T3)时的氧合指数、手术时间、机械通气时间、晶胶体输入量、出血量、尿量、血管活性药物用量、术后不良事件、术后住院时间等.结果 P组与C组术中晶体输入量分别为每小时(4.6±1.6)ml/kg和(6.6±1.6)ml/kg,胶体输入量分别为每小时(3.0±1.1) ml/kg和(4.5±1)ml/kg,术后氧合指数分别为(359.6±37.5) mmHg和(309.3±23.4) mmHg,两组比较差异均有统计学意义(P＜0.05).结论 运用PPV指导胸腔镜下肺部分切除术术中液体管理能改善氧合指数,可减轻术后急性肺部损伤.%Objective To evaluate the effect of pulse pressure variation(PPV)-guided fluid infusion on perioperative oxygenation index and short-term prognosis in patients undergoing video-assisted thoracoscopic pneumectomy.Methods Fifty-two patients undergoing video-assisted thoracoscopic pneumectomy were randomly divided into two groups:group C,conventional therapy group (n =26),in which patients received fluid therapy according to heart rate,mean arterial pressure,urine output;group P,PPV group(n =26),in which patients received fluid therapy to keep PPV between 3％ and 7％.The two groups were compared in oxygenation index(PaO2/FiO2) at T1 (before induction),T2(5 minutes before the end of one-lung ventilation),T3 (48 h after the operation),respectively.The duration of surgery and mechanical ventilation,intraoperative volume of crystalloid and colloid administered,total blood loss as well as the length of postoperative hospital stay for each patient were recorded.The postoperative and intraoperative one-month morbidity of patients received vasopressor or diuresis were noted.Results The volumes of crystalloid and colloid in the group P were significantly less than those in the group C [(4.6 ± 1.6)ml/(kgh)vs.(6.6 ± 1.6)ml/(kgh),(3.0 ±1.1) ml/(kgh) vs.(4.5 ± 1)ml/(kgh),both P＜ 0.05].The postoperative oxygenation index in the group P was significantly higher than that in the group C [(359.6 ± 37.5) mmHg vs.(309.3 ± 23.4) mmHg,P ＜ 0.05].Conclusion The patients received PPV-guided fluid therapy for peumectomy may have improved oxygenation index and decreased acute lung injury.