您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报(医学版) ›› 2015, Vol. 53 ›› Issue (6): 82-85.doi: 10.6040/j.issn.1671-7554.0.2014.542

• 临床医学 • 上一篇    下一篇

目标导向性液体治疗对老年患者腹部外科手术的影响

潘国政, 由法平, 王帅, 卜庆敖, 袁庆忠   

  1. 胜利油田中心医院肝胆外科, 山东 东营 257034
  • 收稿日期:2014-08-19 修回日期:2015-03-19 发布日期:2015-06-10
  • 通讯作者: 袁庆忠。 E-mail:dyyqz@126.com E-mail:dyyqz@126.com
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金(320.6750.13235)

Effect of goal-directed fluid therapy on abdominal surgery in elderly patients

PAN Guozheng, YOU Faping, WANG Shuai, BU Qing'ao, YUAN Qingzhong   

  1. Department of Hepatobiliary Surgery, Central Hospital of Shengli Oilfield, Dongying 257034, Shandong, China
  • Received:2014-08-19 Revised:2015-03-19 Published:2015-06-10

摘要: 目的 探讨目标导向性液体治疗对老年患者腹部外科手术的影响。方法 选取2013年5月~2014年11月行腹部外科手术老年患者44例,随机分成目标导向性液体治疗组(A组)和传统液体治疗组(B组)。比较两组患者术中补液量、每分钟尿量、出血量;术后第1天红细胞比容(HCT)、肌酐(CR)、尿素氮(BUN);手术后排气时间、住院天数、并发症发生情况。结果 A组术中补液量、每分钟尿量明显少于B组,差异有统计学意义;A、B两组术中出血量差异无统计学意义;两组患者在术后第1天HCT、CR、BUN差异无统计学意义;A组患者术后排气时间及住院天数均少于B组患者,差异有统计学意义,两组患者术后并发症的发生率差异无统计学意义。结论 在老年患者中,基于每搏输出量的变异度(SVV)的目标导向性液体治疗,术中补液合理,术后肠道功能恢复快,住院时间短,比传统液体治疗更加安全可靠。

关键词: 目标导向性液体治疗, 老年患者, 腹部外科手术

Abstract: Objective To investigate the effect of goal-directed fluid therapy on elderly patients undergoing abdominal surgery. Methods A total of 44 elderly patients who received abdominal surgery in our hospital during May 2013 and Nov 2014 were divided into two groups: goal-directed liquid treatment group (group A) and conventional treatment group (group B). The patients' clinical data were analyzed, including volume of fluid input, volume of urine per minute, intraoperative blood loss, hematocrit (HCT), creatinine (CR), blood urea nitrogen (BUN) on the first day after operation, exhaust time, hospitalization time, and complications. Results The volume of fluid input, volume of urine per minute, exhaust time, and hospitalization time for group A were significantly less/shorter than those for group B. There were no statistical differences in the other indexes between the two groups. Conclusion Goal-directed fluid therapy based on stroke volume variation (SVV) was safer and more reliable than traditional liquid treatment for elderly patients, because the volume of fluid input was more reasonable, and bowel functions recovered sooner.

Key words: Elderly patients, Abdominal surgery, Goal-directed fluid therapy

中图分类号: 

  • R565
[1] 檀俊涛, 徐红萌, 王勇, 等. 应用Flotrac/Vigileo监测系统行目标指导液体治疗对肝癌切除术患者围术期容量治疗效应[J]. 中国肿瘤临床, 2012, 39(23): 1968-1971.
[2] 周涛, 郭善亮, 张明生. 目标导向液体治疗在老年患者胃肠道手术中的应用[J]. 临床麻醉学杂志, 2013, 29(10): 973-974.
[3] Strunden MS, Heckel K, Goetz AE, et al. Perioperative fluid and volume management: physiological basis, tools and strategies[J]. Ann Intensive Care, 2011, 1(1): 2.
[4] Brandstrup B, Svensen C, Engquist A. Hemorrhage and operation cause a contraction of the extracellular space needing replacement-evidence and implications? A systematic review[J]. Surgery, 2006, 139(3): 419-432.
[5] McArnle GT, McAuley DF, McKinley A, et al. Preliminary results of a prospective randomized trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair[J]. Ann Surg, 2009, 250(1): 28-34.
[6] Gonzalez-Faiardo JA, Mengibar I, Brizuela JA, et al. Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery[J]. Eur J Vasc Endovasc Surg, 2009, 37(5): 538-543.
[7] Wenkui Y, Ning L, Jianfeng G, et al. Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy[J]. Surgery, 2010, 147(4): 542-552.
[8] Lobo SM, Ronchi LS, Oliveira NE, et al. Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery[J]. Crit Care, 2011, 15(5): R226.
[9] 俞瑞东, 陆小川, 宋晓华, 等. 围手术期限制性液体治疗对老年病人术后并发症和预后的影响[J]. 中国实用外科杂志, 2012, 32(10): 853-855.
[10] Futier E, Constantin JM, Petit A, et al. Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial[J]. Arch Surg, 2010, 145(12): 1193-2000.
[11] 蔡勤芳, 米卫东, 袁维秀. 脉搏灌注指数变异监测机体容量状况的临床研究[J]. 中华外科杂志, 2010, 48(21): 1628-1632. CAI Qinfang, MI Weidong, YUAN Weixiu. The ability of pleth variability index to predict fluid responsiveness in mechanically ventilated patients under general anaesthesia[J]. CHINESE JOURNAL OF SURGERY, 2010, 48(21): 1628-1632.
[12] Cecconi M, Fasano N, Langano N, et al. Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia[J]. Crit Care, 2011, 15(3): R132.
[13] Jammer I, Uivik A, Erichsen C, et al. Does central venous oxygen saturation-directed fluid therapy affect postoperative morbidity after colorectal surgery? A randomized assessor-blinded controlled trial[J]. Anesthesiology, 2010, 113(5): 1072-1080.
[14] Wenkui Y, Ning L, Jianfeng G, et al. Restricted Peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy[J]. Surgery, 2010, 147(4): 542-552.
[15] 李艳珍, 曾凯, 朱小峰, 等. 目标导向液体治疗对老年高血压胃癌根治术患者术后并发症的影响[J]. 中华高血压杂志, 2013, 21(11): 1701-1705.
[1] 朱雷, 赵志斌, 冯继英, 朱品, 栾恒飞, 张小宝. 超声引导测量下腔静脉直径用于快速评估术前老年患者血容量的价值[J]. 山东大学学报(医学版), 2014, 52(10): 96-99.
[2] 展振江1,李明1,张元凯1,白恩忠2. PFNA与DHS治疗老年股骨粗隆间不稳定性骨折疗效对比[J]. 山东大学学报(医学版), 2013, 51(12): 92-94.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!