本文關(guān)鍵詞： 脈搏灌注變異指數(shù) 目標(biāo)導(dǎo)向液體治療 開(kāi)顱手術(shù)　出處：《安徽醫(yī)科大學(xué)學(xué)報(bào)》2017年07期 　論文類型：期刊論文

【摘要】：目的探討脈搏灌注變異指數(shù)(PVI)目標(biāo)導(dǎo)向液體治療在神經(jīng)外科開(kāi)顱手術(shù)患者的臨床應(yīng)用價(jià)值。方法 76例擇期行開(kāi)顱手術(shù)患者隨機(jī)分為PVI指導(dǎo)補(bǔ)液組(n=38)和對(duì)照組(n=38)。誘導(dǎo)期兩組均靜脈輸注乳酸鈉林格6~8ml/kg,維持期PVI指導(dǎo)補(bǔ)液組背景輸注乳酸鈉林格2 ml/(kg·h),當(dāng)PVI值連續(xù)5 min以上高于14%,快速輸注3ml/kg羥乙基淀粉氯化鈉(6%HES);對(duì)照組背景輸注乳酸鈉林格4~6 ml/(kg·h),當(dāng)MAP8.67 k Pa快速輸注100~250 ml 6%HES。記錄術(shù)中液體輸入總量、晶體量、膠體量、尿量、出血量、手術(shù)時(shí)間、麻醉時(shí)間;于誘導(dǎo)前(T_0)、手術(shù)前(T_1),剝除腫瘤時(shí)(T_2)、術(shù)畢(T_3)采集動(dòng)脈血測(cè)血?dú)夥治鲋?于術(shù)后第1、2、3、7、30天分別隨訪并發(fā)癥發(fā)生率及恢復(fù)情況。結(jié)果兩組一般資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義;與對(duì)照組比較,PVI指導(dǎo)補(bǔ)液組液體總輸入量和晶體液輸入量減少,膠體液輸入量增加(P0.05);兩組血?dú)夥治鲋?Lac、pH、Glu、BE)各時(shí)間點(diǎn)比較差異無(wú)統(tǒng)計(jì)學(xué)意義。與對(duì)照組比較,PVI指導(dǎo)補(bǔ)液組術(shù)后并發(fā)癥顏面部腫脹發(fā)生率減少,術(shù)后排便時(shí)間和術(shù)后住院時(shí)間縮短(P0.05)。結(jié)論 PVI目標(biāo)導(dǎo)向液體治療用于神經(jīng)外科開(kāi)顱手術(shù)能優(yōu)化術(shù)中輸液,降低術(shù)后水腫并發(fā)癥的發(fā)生率,促進(jìn)患者恢復(fù)。
[Abstract]:Objective to evaluate the clinical value of targeted fluid therapy with pulse perfusion variability index (PVI) in patients undergoing craniotomy in neurosurgery. Methods 76 patients undergoing elective craniotomy were randomly divided into two groups: PVI guided fluid replacement group (PVI) and control group (n = 38). During induction period, both groups were given intravenous infusion of sodium lactate, Ringer (6ml / kg), PVI during maintenance period, background infusion of sodium lactate (2 ml/(kg 路hg), and rapid infusion of 3ml / kg hydroxyethyl starch sodium chloride (3ml / kg) to control group (control group), when PVI value was more than 5 min above 14 min. Sodium Ringer (6 ml/(kg 路hg). When MAP8.67 KPA was infused quickly with 100ml of 250ml and 6hes, the total volume of fluid input during operation was recorded. The volume of crystal, colloid, urine, blood loss, operation time, anesthesia time, before induction, before operation, before operation, T _ 1, T _ 2, T _ 2T _ 2, T _ (3)) were collected. The incidence of complications and recovery were observed at 730 days after operation. Results there was no significant difference in general data between the two groups, and the total fluid input and crystal fluid input were decreased in the PVI guided rehydration group compared with the control group. There was no significant difference between the two groups in the blood gas analysis value and the pH value of Lactein Glube. Compared with the control group, the incidence of postoperative complications of facial swelling in the PVI guided fluid replacement group was decreased, and there was no significant difference between the two groups in blood gas analysis. Conclusion PVI targeted fluid therapy for neurosurgical craniotomy can optimize the intraoperative infusion, reduce the incidence of postoperative edema complications and promote the recovery of patients.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科;
【基金】：衛(wèi)生部公益性行業(yè)科研專項(xiàng)基金項(xiàng)目(編號(hào):3101005002154)
【分類號(hào)】：R614

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