| 胡梦莹,李娟,康芳,等.不同液体治疗目标对老年食管癌根治患者术后恢复的影响[J].中国临床保健杂志,2021,24(6):776-780. |
| 不同液体治疗目标对老年食管癌根治患者术后恢复的影响 |
| Effect of different target-directed fluid therapy on the recovery of older patients undergoing esophageal cancer surgery |
| 投稿时间：2021-09-15 |
| DOI：10.3969/J.issn.1672-6790.2021.06.012 |
| 中文关键词: 食管肿瘤 食管切除术 每搏输出量 中心静脉压 手术后并发症 生活质量 老年人 |
| 英文关键词: Esophageal neoplasms Esophagectomy Stroke volume Central venous pressure Postoperative complications Quality of life Aged 〖FL |
| 基金项目: |
|
| 摘要点击次数: 1963 |
| 全文下载次数: 2738 |
| 中文摘要: |
| 目的 探讨不同液体治疗目标对老年患者行胸腹腔镜联合Mckeown食管切除术术后恢复的影响。方法 选择2019年1月至2020年12月行食管癌根治术老年患者80例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,年龄60～80岁,体重指数(BMI) 18～25 kg/m2。所有患者采用随机数字表法分为两组,每组随机分入40例。以中心静脉压(CVP)为液体治疗目标,保持CVP于10～12 mmHg(1 mmHg=0.133 kPa)的变化范围调整补液和血管活性药物为C组,以每搏量变异率(SVV)为液体治疗目标,维持SVV<13%为S组。记录两组老年食管癌患者的手术总时间,术中总输液量及输液种类,术中出血量,尿量,术中血管活性药物的使用比例以及住院天数；分别于麻醉诱导前(T0),手术开始后1 h(T1),2 h(T2),术毕(T3)4个时刻抽取患者动脉血行血气分析监测血乳酸(Lac)；由不同的医师术前1天和术后3天评估患者术后的自理能力,疼痛评分和医疗支持等15项指标[采用15项恢复质量评分量表(QoR-15量表) 评估]；记录各组患者术后并发症(谵妄和肺部并发症)的数量。结果 与C组比较,S组术中总输液量,胶体液量和尿量较高(P<0.05),但血管活性药使用比例低于C组(P<0.05)；与T0时比较,两组患者的T2和T3时刻Lac明显升高(P<0.05),并且T2和T3时刻S组的Lac含量较低(P<0.05)；除自理能力,疼痛评分和医疗支持外,S组患者术后3 d时的QoR-15量表评分明显升高(P<0.05)；S组患者术后谵妄,肺部并发症发生率明显下降(P<0.05)。结论 相比于传统以CVP为目标指导的液体治疗,以SVV为目标指导的液体治疗可以优化老年食管癌手术患者围术期液体管理,维持有效的脏器灌注,有利于提高患者术后恢复质量,降低老年食管癌患者术后并发症。 |
| 英文摘要: |
| Objective To investigate the effect of different target-directed fluid therapy on the recovery of older patients undergoing esophageal cancer surgery.Methods Eighty elderly patients were selected for radical resection of esophageal cancer,including 42 males and 38 females,with ASA grade Ⅱ - Ⅲ,age 60 to 80 years old,body mass index (BMI) 18 to 25 kg/m2.All patients were divided into two groups by random number table method,and each group was randomly divided into 40 cases.The central venous pressure (CVP) was used as the target of fluid therapy,and the range of CVP was maintained at 10-12 mmHg.Fluid infusion and vasoactive drugs were used as group C,and SVV was used as the target of fluid therapy,to maintain SVV＜13% were in the group S.The total operation time,total infusion volume and infusion type,intraoperative blood loss,urine volume,proportion of intraoperative vasoactive drugs and hospitalization days of elderly patients with esophageal cancer in the two groups were recorded.Arterial blood was extracted for blood gas analysis to monitor blood lactic acid (Lac) at 4 moments before induction of anesthesia (T0),1 h after operation (T1),2 h after operation (T2),and T3.Postoperative self-care ability,pain score,medical support and other 15 indicators were evaluated by different physicians 1 day before and 3 days after surgery [evaluated by 15-item Quality of recovery Scale (QOR-15 scale)].The number of postoperative complications (delirium and pulmonary complications) in each group was recorded.Results Compared with group C,group S had higher intraoperative total infusion volume,colloid fluid volume and urine volume (P＜0.05),but the proportion of vasoactive drugs was lower than that of group C (P<0.05);compared with T0,Lac was significantly increased at T2 and T3 (P<0.05),and Lac content was lower in group S at T2 and T3 (P<0.05);In addition to self-care ability,pain score,and medical support,the QOR-15 scale score of patients in the group S significantly increased 3 days after surgery (P<0.05);Patients in group S experienced postoperative delirium and the incidence of pulmonary complications decreased significantly (P<0.05).Conclusions Compared with traditional CVP target-guided fluid therapy,SVV target-guided fluid therapy can optimize perioperative fluid management in elderly patients with esophageal cancer surgery,maintain effective organ perfusion,improve postoperative recovery quality and reduce postoperative complications in elderly patients with esophageal cancer. |
|
查看全文
|
| 关闭 |
|
|
|