摘要
目的评价每搏量变异度（SVV）联合控制性低中心静脉压（CLCVP）指导肝癌切除术患者容量治疗的效果。方法择期全麻下拟行肝癌切除术患者70例，年龄40～60岁，体重指数20～25 kg/m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n＝35）：常规补液组（R组）和SVV联合CLCVP指导补液组（SC组）。R组输入液体总量＝补偿性扩容量＋生理需要量＋累计缺失量＋继续损失量＋第3间隙丢失量，维持MAP〉70 mmHg、CVP〈4 cmH2O、HR〈100次/min；SC组维持CVP〈4 cmH2O和SVV〈12%。记录手术时间、晶体液与胶体液总量、尿量、术中低血压和心动过缓发生情况，于诱导前和术毕时取左侧桡动脉和中心静脉血样测定血乳酸浓度并计算氧供指数（DO2I）、氧耗指数（VO2I）、氧摄取率（ERO2）；诱导前和术毕时采取肘静脉血样，测定血清β2-微球蛋白（β2-MG）浓度；记录术中心血管不良事件的发生情况，以及观察术后并发症的发生情况。结果与R组比较，SC组晶体液输注总量减少，胶体液输注总量和尿量增加，术中低血压及心动过缓发生率降低，术毕时DO2I、VO2I和ERO2升高，动脉血乳酸和血清β2-MG浓度、术后肺部感染率降低（P〈0.05）。结论SVV联合CLCVP指导肝癌切除术患者容量治疗的效果优于常规补液。
ObjectiveTo evaluate the efficacy of stroke volume variation（SVV）combined with controlled low central venous pressure（CLCVP）-directed fluid therapy in the patients undergoing liver cancer resection.MethodsSeventy American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 40-60 yr, with body mass index of 20-25 kg/m2, scheduled for elective liver cancer resection under general anesthesia, were divided into 2 groups（n=35 each） using a random number table： routine fluid replacement group（R group） and SVV combined with CLCVP-guided fluid replacement group（SC group）. In R group, routine fluid replacement included compensatory volume expansion, physiological requirement, cumulative loss, continued loss （intraoperative blood loss） and 3rd space losses, maintaining mean arterial pressure〉70 mmHg, central venous pressure〈4 cmH2O and heart rate 〈100 bpm.Central venous pressure was maintained 〈4 cmH2O and SVV 〈12% during operation in SC group.The operation time, total amount of crystalloid and colloid solution infused, urine volume and development of intraoperative hypotension and bradycardia were recorded.Blood samples from the left radial artery and central vein were collected before anesthesia induction and at the end of operation for measurement of the blood lactate concentration, and the oxygen supply index, oxygen consumption index and oxygen uptake rate were calculated.Blood samples from the ulnar vein were collected before anesthesia induction and at the end of operation for determination of serum β2-microglobulin concentrations.The development of intraoperative adverse cardiovascular events was recorded, and the occurrence of postoperative complications was observed.
ResultsCompared with R group, the total amount of crystalloid solution infused was significantly decreased, the total amount of colloid solution infused and urine volume were increased, the incidence of intraoperative hypotension and bradycardia was decreased, oxygen supply index, oxygen consumption index and oxygen uptake rate were increased at the end of operation, and the lactate concentration in arterial blood, serum β2-microglobulin concentration and rate of postoperative pulmonary infection were decreased in SC group （P〈0.05）.ConclusionSVV combined with CLCVP-directed fluid therapy produces better efficacy than routine fluid replacement in the patients undergoing liver resection.
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第8期968-971,共4页
Chinese Journal of Anesthesiology
基金
国家自然科学基金（81670552）
重庆市基础科学与前沿技术研究（cstc2016jcyjA2105）
关键词
每搏输出量
中心静脉压
肝肿瘤
Stroke volume
Central venous pressure
Liver neoplasms
