本文選題：脈搏灌注變異指數(shù) + 目標(biāo)導(dǎo)向液體治療��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討脈搏灌注變異指數(shù)(PVI)指導(dǎo)的容量管理在神經(jīng)外科腫瘤患者開顱手術(shù)患者的臨床應(yīng)用價(jià)值。方法選擇擇期行開顱手術(shù)患者76例,隨機(jī)分為PVI指導(dǎo)補(bǔ)液組(PVI組,n=38)和對照組(CON組,n=38)。誘導(dǎo)期兩組均靜脈輸注乳酸鈉林格6~8 ml?kg-1,維持期PVI組輸注乳酸鈉林格2 ml?kg-1?h-1,當(dāng)PVI值連續(xù)5 min以上高于14%,快速輸注3 ml?kg-1羥乙基淀粉氯化鈉(6%HES);CON組輸注乳酸鈉林格4~6ml?kg-1?h-1,當(dāng)MAP65 mm Hg,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(T0)、手術(shù)前(T1),切除腫瘤時(shí)(T2)、術(shù)畢(T3)采集動脈血行血?dú)夥治?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統(tǒng)計(jì)學(xué)意義(P0.05);與CON組比較,PVI組液體總輸入量減少、晶體液輸入量減少、膠體液輸入量增加(P0.05);兩組患者血?dú)夥治鲋?Lac、p H、Glu、BE)各時(shí)間點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05。與CON組比較,PVI組術(shù)后并發(fā)癥顏面部腫脹發(fā)生率減少(P0.05);術(shù)后排便時(shí)間和術(shù)后住院時(shí)間縮短(P0.05)。結(jié)論1,PVI指導(dǎo)的目標(biāo)導(dǎo)向液體治療用于神經(jīng)外科開顱手術(shù)能減少術(shù)中輸液總量,優(yōu)化術(shù)中輸液。2,PVI指導(dǎo)的目標(biāo)導(dǎo)向液體治療用于神經(jīng)外科開顱手術(shù)能降低術(shù)后水腫相關(guān)并發(fā)癥的發(fā)生率;促進(jìn)患者恢復(fù)。
[Abstract]:Objective to investigate the clinical value of volume management guided by PVI in patients with neurosurgical tumors undergoing craniotomy. Methods 76 patients undergoing elective craniotomy were randomly divided into two groups: PVI group (PVI group) and control group (Con group). During induction period, both groups were given intravenous infusion of sodium lactate, Ringer, 8 ml / kg -1, and maintenance group, sodium lactate, Ringer, 2 ml / kg -1 h -1, respectively. When the value of PVI was higher than 14 min in a row, rapid infusion of 3 ml?kg-1 hydroxyethyl starch sodium chloride 6HESCON group was infused with Ringer lactate 6 ml / kg -1 h-1, when MAP65 mm. HG, quick infusion of 100ml, 250ml, 6HES5. The total volume of fluid input, crystal volume, colloid quantity, urine volume, blood loss, operation time and anesthesia time were recorded during the operation, and arterial blood gas was collected before induction, before operation, at the time of resection of tumor, after operation, arterial blood was collected for blood gas analysis. The complication rate and recovery were followed up at 730 days after operation. Results there was no significant difference in general data between the two groups (P 0.05), but the total liquid input and crystal liquid input in the PVI group were decreased compared with those in the Con group. There was no significant difference in blood gas analysis between the two groups (P 0.05). Compared with the Con group, the postoperative complications of PVI group decreased the incidence of facial swelling and shortened the postoperative defecation time and postoperative hospitalization time. Conclusion (1) the target oriented fluid therapy guided by PVI can reduce the amount of fluid infusion in neurosurgical craniotomy. Optimizing the target oriented fluid therapy guided by intraoperative infusion of PVI for neurosurgery craniotomy can reduce the incidence of postoperative edema related complications and promote the recovery of patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 田勝蘭;周游;馮丹;;目標(biāo)導(dǎo)向液體治療在擇期神經(jīng)外科手術(shù)中對顱內(nèi)壓和腦氧供需平衡的影響[J];華中科技大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年01期

2 蘇建林;譚衛(wèi);黃斌;陽子華;蔣奕紅;;顱內(nèi)幕上腫瘤術(shù)中血糖波動水平與術(shù)后血清炎性因子對患者短期預(yù)后的影響[J];臨床麻醉學(xué)雜志;2014年03期

3 宋秋鳴;武道榮;馮開俊;;動脈血乳酸清除率及堿剩余在感染性休克患者中的動態(tài)監(jiān)測價(jià)值[J];實(shí)用醫(yī)學(xué)雜志;2013年21期

4 袁柳青;李鳳仙;劉世樂;許睿;張慶國;徐世元;;目標(biāo)導(dǎo)向液體治療對腦膜瘤切除術(shù)患者腦氧代謝的影響[J];臨床麻醉學(xué)雜志;2013年04期

5 何新全,鄭奕萍;危重病患者血乳酸檢查的臨床評價(jià)[J];四川醫(yī)學(xué);2003年08期

6 蔡勤芳;米衛(wèi)東;袁維秀;;脈搏灌注指數(shù)變異監(jiān)測機(jī)體容量狀況的臨床研究[J];中華外科雜志;2010年21期

，

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