每搏变异度指导肝叶切除术容量管理的临床研究

目的探讨每搏变异度(SVV)在肝叶切除术中指导容量管理的可行性。方法收集我院2015年6月~2016年6月行肝叶切除术患者60例,分为观察组(CVP维持在0~5cm H_2O,SVV维持在10%±2%),对照组(CVP维持在0~5 cm H_2O)。记录两组病人各时间段的血流动力学情况,包括麻醉后30 min(T_1)、肝叶切除结束时刻(T_2)、手术结束即刻(T_3)。记录两组病人术前一天(A),肝叶切除结束后(B)和术后第一天(C)的血红蛋白(Hb),血细胞压积(HCT),肌酐(Cr)和尿素氮(BUN)水平。记录两组病人的手术切肝时间,术中出血量、尿量,术后胃肠道功能恢复时间、住院天数和并发症发生率。结果两组患者性别、年龄、体重、肝功能分级上差异无显著的统计学意义(P0.05)。两组患者各时间段T_1、T_2、T_3的血流动力学比较,观察组患者差异均无统计学意义。对照组患者有创血压(ABP)和中心静脉压(CVP)比较差异无显著统计学意义(P0.05),心输出量(CO)、心率(HR)T_2、T_3与T1比较,差异有统计学意义(P0.05)。观察组患者术前、术后各项化验指标比较差异均无统计学意义(P0.05)。对照组患者比较尿素氮水平差异无统计学意义(P0.05),血红蛋白、血细胞压积和肌酐水平比较差异有统计学意义(P0.05)。两组患者临床资料除尿量变化不大,其切肝时间、出血量、术中补液、胃肠道恢复时间、住院天数和并发症发生率比较差异有显著统计学意义(P0.05)。结论肝叶切除术中应用SVV动态指导容量管理,有利于术中控制出血量及减少输血量,缩短手术时间,对患者进行优化、个体化补液。

An investigation of volume administration guided by stroke volume variation in hepatolobec- tomy

Objective To investigate the effect of stroke volume variation （SVV）as an indexof volume administration in hepatolobectomy. Methods Sixty patients undergoing hepatolobectomy wereassigned to two groups，the observation group（Group S，CVP weas maintained at 0-5 cm H2O and SVVmaintained at 10±2%）and the control group （Group C ，CVP was maintained at 0-5 cm H2O）. Thehemodynamics of two groups of patients were recorded at certain time points ，including the 30 minutesafter anesthesia（T1），the end time of hepatectomy（T2），and the end time of operation（T3）. The hemo?globin（Hb），blood cell volume （HCT），creatinine（Cr）and urea nitrogen （Bun）levels of the twogroups were recorded the day before the operation（A），the first day after hepatectomy（B）and the dayafter the operation（C）. The operation time，amount of bleeding and urine，the recovery time of gastrointes?tinal function，the length of hospital stay and the incidence rate of complications of the two groups wererecorded. Results There were no significant differences in gender，age，body weight and liver functionbetween the two groups. The comparison of blood flow dynamics of the two groups of patients at T1 ，T2 andT3 had no statistically significant difference in Group S patients. There was no significant difference in invasive blood pressure（ABP）and central venous pressure（CVP）in Group C patient；there was significant difference in cardiac output（CO）and heart rate（HR）T2，T3 and T1 comparisons（P<0.05）. There was no significant difference in the preoperative and postoperative laboratory indexes of Group S（P>0.05）. There was no significant difference in the level of urea nitrogen（P>0.05）；there was significant difference in hemoglobin，blood cell pressure and creatinine levels in Group C patients（P<0.05）. The clinical data of the two groups showed little change in urine volume；the liver cutting time，blood loss，intraoperative fluid，gastrointestinal recovery time，hospitalization time and complications showed significant difference in the incidence rate（P<0.05）. Conclusion Liver resection operation under SVV dynamic guidance capacity management is conducive to the control of intraoperative bleeding and reduction blood loss，shortens the operation time，optimizes the individualized rehydration.