本文選題：每博量變異度/SVV　切入點(diǎn)：液體治療　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的每博量變異度(Stroke volume variation,SVV)是一種準(zhǔn)確、方便的測(cè)量液體反應(yīng)性和功能性的血流動(dòng)力學(xué)參數(shù)。而以SVV為導(dǎo)向目標(biāo)的液體治療也是一種限制性液體治療,往往不足以穩(wěn)定患者的病情,尤其是老年患者。由于老年患者心血管功能下降,加之術(shù)前禁食禁飲,術(shù)前消化道準(zhǔn)備,以及術(shù)中麻醉藥的心血管抑制作用等原因,更易引起術(shù)中血流動(dòng)力學(xué)波動(dòng),大大增加圍術(shù)期風(fēng)險(xiǎn)。相關(guān)文獻(xiàn)研究表明在老年患者限制性輸液引起低血壓時(shí),預(yù)防性給予小劑量去甲腎上腺素,能有效的增加組織氧供,減少術(shù)后并發(fā)癥的發(fā)生,且無(wú)明顯胃腸道微循環(huán)及氧耗的不良影響。鑒于去氧腎上腺素在臨床上相對(duì)于去甲腎上腺素更為常用,本課題擬在SVV導(dǎo)向液體治療基礎(chǔ)上進(jìn)行前瞻性、單中心、隨機(jī)、雙盲對(duì)照研究,觀察去甲腎上腺素與去氧腎上腺素對(duì)結(jié)(直)腸癌根治術(shù)患者的預(yù)后對(duì)比,評(píng)價(jià)兩種升壓藥物對(duì)患者的安全性,并找到一個(gè)可行的圍手術(shù)期液體治療優(yōu)化方案。方法本課題研究對(duì)象為擇期行結(jié)(直)腸癌根治術(shù)患者。采用隨機(jī)數(shù)字表法將患者隨機(jī)分為去甲腎上腺素(5μg/ml)組和去氧腎上腺素(100μg/ml)組,每組各20例�；颊呷胧液笤诰致橄滦袠飫�(dòng)脈穿刺置管測(cè)壓,并連接FloTrac/Vigileo監(jiān)測(cè)系統(tǒng)監(jiān)測(cè)SVV、心指數(shù)(Cardiac index,CI)、心輸出量(Cardiac output,CO)等指標(biāo),局麻下行中心靜脈穿刺,連接靜脈通路并監(jiān)測(cè)中心靜脈壓(Central venous pressure,CVP)。術(shù)中液體背景輸注速度5ml/kg.h,根據(jù)SVV調(diào)控液體輸注速度及種類。若血壓低于基礎(chǔ)值的20%,則泵入去甲腎上腺素或去氧腎上腺素。兩種血管活性藥的背景輸入量為5ml/h。主要觀察指標(biāo)為:術(shù)后腎功、ICU入住時(shí)間、ICU機(jī)械通氣時(shí)間、住院花費(fèi)、術(shù)后第一天急性生理和慢性健康評(píng)估II(APACHE II)評(píng)分、排氣時(shí)間、住院天數(shù)、術(shù)后并發(fā)癥、28天患者再入院率及死亡率。次要觀察指標(biāo):分別在入室平穩(wěn)后、動(dòng)脈穿刺后、麻醉誘導(dǎo)前、插管即刻、插管后3min、手術(shù)開(kāi)始、手術(shù)結(jié)束及手術(shù)開(kāi)始后每隔30min記錄病人基本情況(Bp、HR、SpO2、ABP、CO、SVV、CI、SV、CVP、Bis、ETCO2、T)、術(shù)中血管活性藥物使用量(ml)、多巴酚丁胺是否使用及使用量、術(shù)中尿量、利尿藥使用量、晶體入量、膠體入量、及術(shù)中輸注其他液體入量、術(shù)中失血量、麻醉時(shí)間。結(jié)果術(shù)中在SVV導(dǎo)向的液體治療下,去甲腎上腺素與去氧腎上腺素對(duì)結(jié)(直)腸癌根治術(shù)患者的術(shù)中觀察指標(biāo)及術(shù)后預(yù)后觀察指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異。兩組術(shù)中Bp、HR、SpO2、ABP、CO、SVV、CI、SV、CVP、Bis、ETCO2、T、術(shù)中血管活性藥物使用量(ml)、多巴酚丁胺是否使用及使用量、術(shù)中尿量、利尿藥使用量、晶體入量、膠體入量、及術(shù)中輸注其他液體入量、術(shù)中失血量、麻醉時(shí)間均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。兩組在術(shù)后腎功、ICU入住時(shí)間、ICU機(jī)械通氣時(shí)間、住院花費(fèi)、排氣時(shí)間、住院天數(shù)、術(shù)后并發(fā)癥、28天患者再入院率及死亡率均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。去氧腎上腺素組術(shù)后APACHE II評(píng)分較去甲腎上腺素組更低一些,兩組有統(tǒng)計(jì)學(xué)差異(P=0.048)。這與去氧腎上腺素組在ICU機(jī)械通氣時(shí)間相關(guān),去氧腎上腺組的ICU通氣時(shí)間平均為2.8 h,而去甲腎上腺素組的ICU通氣時(shí)間平均為4.9 h,所以去氧腎上腺素組加速了ICU拔管時(shí)間,而在術(shù)后并發(fā)癥及組織氧合方面無(wú)明顯差異,所以去氧腎上腺素也是一種良好的,可以用于術(shù)中的血管活性藥。結(jié)論術(shù)中在SVV導(dǎo)向的液體治療下,去甲腎上腺素與去氧腎上腺素對(duì)結(jié)(直)腸癌根治術(shù)患者的術(shù)后預(yù)后影響基本相同。在無(wú)心功能障礙的患者術(shù)中應(yīng)用去氧腎上腺素也是一種良好的選擇,在預(yù)后上與去甲腎上腺素相比無(wú)明顯差異。
[Abstract]:Objective stroke volume uariability (Stroke volume, variation, SVV) is a kind of accurate measurement of liquid reaction and functional hemodynamic parameters conveniently. The liquid treatment with SVV as the orientation is also a kind of restrictive fluid therapy, is often not enough to stabilize the patient's condition, especially in elderly patients. Due to the decline in cardiovascular the function of elderly patients with preoperative fasting, gastrointestinal preparation before surgery, and intraoperative anesthetic inhibition of cardiovascular and other reasons, more likely to cause hemodynamic fluctuations during operation, greatly increased perioperative risk. Relevant literature research shows that in the elderly patients with restrictive transfusion induced hypotension, giving small doses of preventive norepinephrine can effectively increase oxygen supply, reduce the incidence of postoperative complications, and no obvious adverse effects on gastrointestinal tract microcirculation and oxygen consumption. In view of phenylephrine in clinical factors Compared with norepinephrine is more commonly used in this study were prospectively, based on SVV directed fluid therapy on a single center, randomized, double-blind study, observation of norepinephrine and phenylephrine on node (straight) comparison of prognosis for patients with colorectal cancer radical, evaluation of two kinds of drugs to boost patient safety, and to find a feasible perioperative fluid therapy optimization. Methods the research objects as nodes (straight) undergoing resection of colorectal cancer patients. According to the random number table method were randomly divided into norepinephrine (5 g/ml) group and phenylephrine (100 g/ml) group, 20 cases in each group. Patients under local anesthesia for radial artery puncture manometry, and FloTrac/Vigileo connection monitoring system SVV, cardiac index (Cardiac index, CI), cardiac output (Cardiac, output, CO) and other indicators, local anesthesia for central venous puncture, venous connection Access and monitoring central venous pressure (Central venous, pressure, CVP). The liquid background infusion rate during 5ml/kg.h, according to the SVV regulation of the liquid infusion rate and type. If the blood pressure lower than the baseline value of 20%, while pumping norepinephrine or phenylephrine. Background input two kinds of vasoactive drugs as the main observation index 5ml/h. as the renal function after operation, ICU ICU check-in time, mechanical ventilation time, hospitalization costs, the first day of II evaluation of acute physiology and chronic health after surgery (APACHE II) score, exhaust time, hospitalization time, postoperative complications, 28 days the patient readmission rate and mortality. Secondary outcome measures: in the stationary burglary after arterial puncture, before anesthesia induction, intubation and 3min after intubation, surgery, surgery and after surgery began to end every 30min record the basic situation of patients (Bp, HR, SpO2, ABP, CO, SVV, CI, SV, CVP, Bis, ETCO2, T), intraoperative vasoactive 鑽墿浣跨敤閲，

本文編號(hào)：1636511