2019 年第 2 期 第 14 卷

每搏变异度指导的液体目标导向治疗在胸腔镜手术中的应用

Application of target oriented liquid therapy based on stroke volume variation in thoracoscopic surgery

作者：雷敏鲍琪钟泰迪

英文作者：

单位：310016杭州，浙江大学医学院附属邵逸夫医院麻醉科

英文单位：

关键词：胸腔镜肺叶切除术；每搏变异度；液体目标导向治疗

英文关键词：

• 摘要：

• 【摘要】目的    评估每搏变异度(SVV)对胸腔镜肺叶切除术患者术中液体目标导向治疗的指导作用。方法    选取2016年1—12月于浙江大学医学院附属邵逸夫医院择期行胸腔镜肺叶切除术的患者44例，采用随机数字表法分为对照组和SVV组，各22例。2组均在麻醉诱导期快速静脉输注晶体液250 ml，随后以2～8 ml/(kg·h)的速率持续静脉输注。对照组当平均动脉压（MAP）＜65 mmHg（1 mmHg=0.133 kPa）时快速输入胶体液并给予间羟胺0.5 mg，维持MAP≥65 mmHg。SVV组当SVV＞11%时快速输入胶体液至SVV≤11%，给予间羟胺0.5 mg，维持MAP≥65 mmHg。记录患者术中液体出入量，采集动脉血进行血气分析及乳酸测定，记录患者住院时间和术后30 d内并发症发生情况。结果    SVV组术中胶体液用量和液体总入量明显少于对照组［（370±131）ml比（488±128）ml、（1 364±330）ml比（1 632±412）ml］（P＜0.05）；2组术中晶体液用量、尿量、出血量差异无统计学意义（P＞0.05）。2组各时间点氧合指数和血乳酸水平差异无统计学意义（P＞0.05）。SVV组住院时间明显短于对照组［（11±4）d比（14±6）d］（P＜0.05）。2组术后30 d内并发症发生率差异无统计学意义（P＞0.05）。结论    SVV指导的液体治疗能够降低术中液体总入量特别是胶体液入量，并能缩短患者住院时间。

• 【Abstract】Objective    To investigate the effect of target oriented liquid therapy with the guidance of stroke volume variation(SVV) on patients undergoing thoracoscopic lobectomy. Methods    From January to December 2016, 44 patients undergoing thoracoscopic lobectomy in Sir Run Run Shaw Hospital, College of Medicine Zhejiang University were randomized into control group and SVV group, with 22 cases in each group. During anesthesia induction, all patients had 250 ml crystalloid bolus followed by crystalloid infusion at 2-8 ml/(kg·h). In the control group, when the mean arterial pressure(MAP) was ＜65 mmHg, colloid was rapidly infused and 0.5 mg metaraminol was given to keep MAP≥65 mmHg. In SVV group, when SVV was ＞11%, colloid was rapidly infused till SVV＜11% and 0.5 mg metaraminol was given to keep MAP≥65 mmHg. Liquid intake and output volume, blood gas and lactic acid content during operation, hospitalization time and postoperative complications within 30 days were analyzed. Results    Colloid intake amount and the total amount of intraoperative fluids in SVV group were significantly less than those in control group［（370±131）ml vs （488±128）ml, （1 364±330）ml vs （1 632±412）ml］（P＜0.05）. Intraoperative crystalloid intake, urine volume and blood loss showed no significant differences between groups（P＞0.05）. Oxygenation index and blood lactic acid level during operation showed no significant differences between groups（P＞0.05）. Hospitalization time in SVV group were significantly shorter than that in control group［（11±4）d vs （14±6）d］（P＜0.05）. Postoperative 30 d complication rate showed no significant difference between groups（P＞0.05）. Conclusion    SVV-guided liquid therapy reduces the intake volume of intraoperative fluids, especially colloid, and shortens the length of hospital stay.