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投稿时间：2019-07-22 网络发布日期：2020-03-20
投稿时间：2019-07-22 网络发布日期：2020-03-20
中文摘要: 目的 观察以每搏量变异度(SVV)、心脏指数(CI)为指导的目标导向液体治疗(GDFT)和以中心静脉压(CVP)、尿量为指导的常规液体治疗对腹腔镜胰十二指肠切除术患者肠道屏障的影响。方法 选取2017年6月至2019年6月择期行腹腔镜胰十二指肠切除术患者60例,根据随机数字表法分为两组,分为GDFT组(G组)和常规液体治疗组(C组),G组将SVV、CI作为GDFT方案,C组以中心静脉压(CVP)、尿量为指导进行液体治疗。记录两组患者手术时间、晶胶体用量、多巴胺和去甲肾上腺素的用量、尿量、出血量、浓缩红细胞输入例数、术后气管拔管时间、住院时间。记录麻醉前(T0)、手术开始(T1)、标本切除时(T2)、手术结束(T3)患者的平均动脉压（MAP）、心率(HR)、CI、CVP、SVV、乳酸(Lac)、中心静脉血氧饱和度（ScvO2）等情况。于T0~T3及术后第 1、2、3 天(T4、T5、T6)7个时间点抽取患者中心静脉血测定血浆二胺氧化酶(DAO)、D-乳酸和LPS的浓度。结果 T2 和T3时间点:与C组比较，G组的MAP、CI、ScvO2升高，CVP、SVV、Lac降低（P<0.05）；G组术中输液总量、晶体液入量均小于C组,胶体液入量和多巴胺使用量多于C组,去甲肾上腺素使用量少于C组,气管插管的拔管时间G组比C组要早（P<0.05）。在T2~T6这5个时间点,G组血浆DAO、D-乳酸和LPS均低于C组（P<0.05）,术后第1天血浆DAO、D-乳酸和LPS均达到峰值,之后开始下降。结论 对腹腔镜胰十二指肠切除术患者,与以 CVP、尿量为指导的常规液体治疗相比,采用以 SVV、CI为指导的GDFT方案治疗能更好维持血流动力学稳定，保证机体组织器官的灌注,并对肠黏膜屏障功能有保护作用。
Abstract:Objective To observe the effects of two kinds of fluid therapy on intestinal barrier in patients undergoing laparoscopic pancreaticoduodenectomy: goal-directed fluid therapy guided by stroke volume variability (SVV) and cardiac index (CI) and conventional fluid therapy guided by central venous pressure (CVP) and urine volume. Methods Sixty patients receiving laparoscopic pancreaticoduodenectomy were randomly divided goal-directed liquid treatment group (group G) and conventional liquid therapy group (group C). SVV and CI guiding fluid therapy was performed in group G, and CVP and urine volume guiding conventional fluid therapy was performed in group C. The operation time, the dosage of crystal colloid, the dosage of dopamine and norepinephrine, urine output, blood loss, number of cases of concentrated red blood cell transfusion, postoperative tracheal extubation time and hospital stay were recorded in two groups. Before anesthesia (T0), at the beginning of operation (T1), at the time of surgical resection (T2), and at the end of operation (T3), MAP, HR, CI, CVP, SVV, lactate(Lac) and central venous blood oxygen saturation (ScvO2) of patients were recorded, and the concentrations of plasma diamine oxidase (DAO), D-lactate and lipopolysaccharide (LPS) were determined at T0-T3 and 1-, 2- and 3- day (T4, T5, T6, respectively) after operation. Results At T2 and T3, MAP, CI, ScvO2 increased, and CVP, SVV, Lac decreased in group G compared with group C(P<0.05); the total amount of intraoperative infusion, the amount of crystalloid fluid and the amount of noradrenaline in group G were less than those in group C, the amount of colloidal fluid and dopamine was more than that in C group(P<0.05), and the extubation time of endotracheal intubation in group G was earlier than that in group C(P<0.05). At T2 to T6 time points, the plasma levels of DAO, D-lactate and LPS in group G were lower than those in group C, and they peaked on the first day after operation and then began to decline in both groups. Conclusion For the patients undergoing laparoscopic pancreatoduodenectomy, goal-directed fluid therapy guided by SVV and CI can better maintain hemodynamic stability, ensure the perfusion of tissues and organs and protect the intestinal mucosal barrier.
keywords: Laparoscopic pancreatoduodenectomy Goal-directed fluid therapy Stroke volume variation Cardiac index Intestinal mucosal barrier function Combined anesthesia
文章编号： 中图分类号： 文献标志码：A
基金项目:
| Author Name | Affiliation |
| PENG Xiao-jing, ZHANG Shu-bo | Department of Anesthesiology, the Hospital Affiliated to North China University of Scienceand Technology, Tangshan, Hebei 063000, China |
引用文本：
彭晓静.目标导向液体治疗对行腹腔镜胰十二指肠切除术患者肠道屏障的影响[J].中国临床研究,2020,33(3):324-328.
彭晓静.目标导向液体治疗对行腹腔镜胰十二指肠切除术患者肠道屏障的影响[J].中国临床研究,2020,33(3):324-328.