目标导向液体治疗对肥胖患者术后康复的影响

目的探讨目标导向液体治疗对肥胖患者术后康复的影响。方法选择择期行腹腔镜袖状胃切除术的重度肥胖患者60例,男28例,女32例,年龄30~55岁,BMI 40~45 kg/m^2,ASAⅡ或Ⅲ级,采用随机数字表法分为两组,每组30例:目标导向液体治疗组(G组)和常规液体治疗组(C组)。G组采用FloTrac/Vigileo监测系统监测每搏量(SV)、每搏量变异度(SVV),维持每搏变异度(SVV)≤13%。C组维持HR及MAP波动幅度不超过术前20%,尿量>0.5 ml·kg^-1·h^-1。记录术中出血量、输注晶体液量、胶体液量及总输液量、尿量以及血管活性药物的使用情况。记录术后拔管时间、术后首次排气时间、术后住院时间。记录术后心血管并发症、肺部并发症和肾功能损害的发生情况。采用GIQLI量表评定术前及术后2、5、10、16周的生存质量。结果与C组比较,G组术中输注晶体液量、总输液量和尿量明显减少(P<0.05),术后首次排气时间、术后住院时间明显缩短(P<0.05),术后心血管并发症、肺部并发症发生率明显降低(P<0.05)。术后2、5、10周G组GIQLI评分明显高于C组(P<0.05)。两组术中出血量、输注胶体液量、血管活性药物使用率、术后拔管时间、肾功能损害发生率差异无统计学意义。结论基于FloTrac/Vigileo监测系统的目标导向液体治疗可促进肥胖患者术后康复,具有一定的临床价值。

Effect of goal-directed fluid therapy on postoperative rehabilitation of obese patients

Objective To investigate the effect of goal-directed fluid therapy on postoperative rehabilitation of obese patients. Methods Sixty severely obese patients undergoing laparoscopic sleeve gastrectomy, 28 males and 32 females, aged 30-55 years, with a BMI 40-45 kg/m^2, falling into ASA physical status Ⅱ or Ⅲ, were divided into two groups with 30 patients in each group. Group G used the FloTrac/Vigileo monitoring system to monitor stroke volume(SV) and stroke volume variation(SVV). In group G, the stroke variability(SVV) was ≤13%. In group C, the fluctuation range of HR and MAP was not more than 20% before surgery, and urine output > 0.5 ml·kg^-1·h^-1. The intraoperative blood loss, the amount of infused crystal fluid, the amount of colloidal fluid, the total infusion volume, urine volume, and the use of vasoactive drugs were recorded. The post-extubation time, the first post-exhaust time, and post-hospitalization time were recorded. Cardiovascular complications, pulmonary complications, and renal impairment were recorded. The GIQLI scale was used to assess the quality of life before and after surgery at 2, 5, 10, and 16 weeks. Results Compared with group C, the amount of intraocular lens fluid, total infusion volume and urine volume in group G were significantly reduced(P < 0.05), and the time of first exhaust and postoperative hospital stay were significantly reduced(P < 0.05), and the incidence of postoperative cardiovascular complications and pulmonary complications were significantly reduced(P < 0.05). The GIQLI score in group G was significantly higher than that in group C at 2, 5, and 10 weeks after operation(P < 0.05). There was no significant difference in the amount of colloidal fluid, the rate of vasoactive drugs, the time of tracheal tube removal, and the damage of renal function between the two groups. Conclusion The goal-directed fluid therapy based on the FloTrac/Vigileo monitoring system can promote postoperative rehabilitation of obese patients and has certain clinical value.