2017 年第 10 期 第 12 卷

目标导向液体治疗在腹膜后肿瘤切除术中的应用

Application of goal-directed fluid therapy in patients undergoing retroperitoneal tumor resection

作者：高志峰冯艺谷洁王晓宇丁琳

英文作者：Gao Zhifeng Feng Yi Gu Jie Wang Xiaoyu Ding Lin

单位：102206北京大学国际医院麻醉科（高志峰、谷洁、王晓宇、丁琳）;100044北京大学人民医院麻醉科(冯艺)

英文单位：Department of Anesthesiology Peking University International Hospital Beijing 102206 China （Gao ZF Gu J Wang XY Ding L）; Department of Anesthesiology Peking University People′s Hospital Beijing 100044 China （Feng Y）

关键词：腹膜后肿瘤；目标导向液体治疗；每搏量变异度

英文关键词：Retroperitonealneoplasms;Goal-directedfluidtherapy;Strokevolumevariation

• 摘要：

• 目的 探讨以每搏量变异度(SVV)、心脏指数和平均动脉压（MAP）为目标进行的目标导向液体治疗(GDFT)对腹膜后肿瘤切除术的术中管理和预后的影响。方法 选取2016年1月至2017年1月在北京大学国际医院行择期腹膜后肿瘤切除术的患者40例，依据随机数字表法分为GDFT组和对照组，各20例。GDFT组患者连接FloTrac/Vigileo系统监测SVV和心脏指数，并将SVV≤12%、心脏指数≥2.5 L/(min·m2)和MAP≥60 mmHg（1 mmHg=0.133 kPa）作为目标进行GDFT。对照组术中采用传统液体治疗。所有患者均监测术中心率、MAP、中心静脉压（CVP）等生命体征，记录手术出入量、血管活性药物用量。术毕测定动脉血氧饱和度、中心静脉血氧饱和度(ScvO2)、动脉血乳酸，并计算氧供指数、氧耗指数、氧摄取率及氧合指数。记录术后拔除气管插管时间、术后排气时间和住院时间。结果 GDFT组MAP、CVP、胶体液量、血管活性药物应用比例明显高于对照组［（81±9）mmHg比（70±6）mmHg、（11.5±2.0）mmHg比（9.3±2.2）mmHg、（1 700±951）ml比（1 060±426）ml、50.0%（10/20）比30.0%（6/20）］，晶体液量、总入量明显低于对照组［（1 580±376）ml比（3 245±1 108）ml、（3 280±1 280）ml比（4 305±1 451）ml］（均P＜0.05）。GDFT组术毕ScvO2、氧供指数、氧耗指数、氧摄取率、氧合指数明显高于对照组［（84±5）%比（81±5）%、（639±71）ml/(kg·h)比（572±66）ml/(kg·h)、（173±49）ml/(kg·h)比（120±41）ml/(kg·h)、（29±5）%比（24±5）%、（329±63）mmHg比（269±65）mmHg］，动脉血乳酸水平明显低于对照组［（1.2±0.5）mmol/L比（1.7±0.7）mmol/L］，拔除气管插管时间和住院时间明显短于对照组［（18±7）min比（24±8）min、（10±3）d比（13±4）d］（均P＜0.05）。结论 GDFT相比于传统液体治疗方法可以减少液体输注量，改善组织灌注，维持氧供需平衡，为腹膜后肿瘤切除术提供更佳的液体治疗方案并改善预后。

• Objective To explore effects of goal-directed fluid therapy（GDFT） directed by stroke volume variation（SVV）, cardiac index（CI） and mean arterial pressure（MAP） on patients undergoing retroperitoneal tumor resection. Methods Totally 40 patients undergoing elective retroperitoneal tumor resection from January 2016 to January 2017 in Peking University International Hospital were randomly divided into GDFT group and control group, with 20 patients in each group. Flotrac/Vigileo monitoring system guided GDFT was applied in GDFT group with target parameters set as SVV≤12%, CI≥2.5 L/（min·m2） and MAP≥60 mmHg. The control group had conventional fluid therapy. Heart rate, MAP, central venous pressure（CVP） were observed during operation; output/input volume and dosage of vasoactive agents were recorded. Arterial oxygen saturation, central venous oxygen saturation（ScvO2） and the level of blood lactate were measured at the end of operation; oxygen supply index（DO2I）, oxygen consumption index（VO2I）, oxygen extraction rate（ERO2） and oxygenation index（OI） were calculated. Postoperative extubation time, exhaust time and length of hospital stay were recorded. Results MAP, CVP, colloid volume and application ratio of vasoactive agents in GDFT group were significantly higher than those in control group［（81±9）mmHg vs （70±6）mmHg, （11.5±2.0）mmHg vs （9.3±2.2）mmHg, （1 700±951）ml vs （1 060±426）ml, 50.0%（10/20） vs 30.0%（6/20）］（P＜0.05）; crystalloid volume and the total input volume in GDFT group were significantly lower than those in control group［（1 580±376）ml vs （3 245±1 108）ml, （3 280±1 280）ml vs （4 305±1 451）ml］（P＜0.05）. At the end of operation, ScvO2, DO2I, VO2I, ERO2 and OI in GDFT group were significantly higher and the level of blood lactate was significantly lower than those in control group［（84±5）% vs （81±5）%,（639±71）ml/（kg·h） vs （572±66）ml/（kg·h）, （173±49）ml/（kg·h） vs （120±41）ml/（kg·h）, （29±5）% vs （24±5）%, （329±63）mmHg vs （269±65）mmHg, （1.2±0.5）mmol/L vs （1.7±0.7）mmol/L］（P＜0.05）. Postoperative extubation time and length of hospital stay in GDFT group were significantly shorter than those in control group［（18±7）min vs （24±8）min, （10±3）d vs （13±4）d］（P＜0.05）. Conclusion GDFT can reduce fluid input volume, optimize tissue perfusion, maintain oxygen delivery-consumption balance, provide better treatment capacity and improve prognosis in patients undergoing retroperitoneal tumor resection.