首页|目标导向液体治疗对改善腹腔镜妇科手术患者术后早期恢复质量的效果

目标导向液体治疗对改善腹腔镜妇科手术患者术后早期恢复质量的效果

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目的 观察基于每搏量变异度(SW)和心脏指数(CI)的目标导向液体治疗(GDFT)对改善腹腔镜妇科手术患者术后早期恢复质量的效果.方法 择期在全身麻醉下行腹腔镜妇科非肿瘤手术患者90例,随机分为常规液体治疗策略组(C组)和基于SVV和CI的GDFT策略组(G组),每组45例.C组患者依据常规液体治疗策略,计算术前每日生理需要量+术前禁饮食所致液体缺失量和术前累计液体丢失量+术中失血量+代偿性血管扩张量+第三间隙丢失量,维持术中血流动力学稳定;G组根据SW及CI进行个体化GDFT液体管理策略,包括维持SVV8%~13%和CI 2.5~4.0 L·min-1·m-2.记录两组患者术中液体出入量以及血管活性药物的使用情况;记录两组患者术前(T0)、气腹10min(T1)、气腹60 min(T2)及术毕(T3)时的HR、MAP、心输出量(CO)及每搏量(SV)等血流动力学指标;记录两组患者麻醉苏醒时间、首次肠鸣音出现时间、首次排便时间及排气时间.两组患者分别于术前1 d及术后3 d进行40项恢复质量评分量表(QoR-40)评分及失眠严重程度指数量表(ISI)评分,记录两组患者术后并发症发生情况.结果 G组术中晶体液输注量、总液体输注量及去甲肾上腺素用量低于C组,而胶体液输注量高于C组(P<0.05).G组T2时SV及T2、T3时CO高于C组(P<0.05).G组术后3 d QoR-40总分高于C组,而ISI评分低于C组(P<0.05).G组患者术后恶心呕吐发生率低于C组,首次肠鸣音出现时间、首次排气及排便时间短于C组(P<0.05).结论 基于SW和CI的GDFT策略可有效维持腹腔镜妇科手术患者血流动力学稳定,降低术后恶心呕吐发生率,促进术后胃肠功能恢复,改善患者术后早期睡眠及恢复质量.
Efficacy of goal-directed fluid therapy in improving the quality of early recovery on patients undergoing laparoscopic gynecological surgery
Objective To observe the efficacy of goal-directed fluid therapy(GDFT)in improving the quality of early recovery in the patients undergoing laparoscopic gynecological surgery.Methods A total of 90 patients undergoing laparoscopic gynecological surgery under general anesthesia were randomly divided into two groups of C and G with 45 cases each.The patients in group C underwent conventional fluid therapy strategy based on preoperative daily physiological requirement,preoperative fluid loss due to dietary restriction and preoperative cumulative fluid loss,intraoperative blood loss,compensatory vasodilation and third space loss in order to maintain intraoperative hemodynamic stability.The patients in group G received individualized GDFT strategy based on SVV and CI,which included keeping the SVV from 8%to 13%and CI from 2.5 to 4.0L·min-1·m-2.The intraoperative fluid intake and outflow and the use of vasoactive drugs were recorded and analyzed.The hemodynamic parameters such as HR,MAP,cardiac output(CO)and stroke volume(SV)were recorded before surgery(T0),10 minutes(T1)and 60 minutes(T2)after pneumoperitoneum,and at the end of operation(T3).The times for revival,recovery of bowel sound,first defecation and exhaust were recorded.The Quality of Recovery-40 Scale(QoR-40)and Insomnia Severity Index(ISI)were evaluated one day before surgery and 3 days after surgery,respectively.The incidence of postoperative complication was recorded.Results The requirements for crystalloid and total volume of fluid infused and vasoactive agents were lower in group G than those in group C,and the requirement for colloid was higher in group G than that in group C(P<0.05).The SV at T2 and CO at T2 and T3 in group G were higher than those in group C(P<0.05).The total QoR-40 score of group G was higher than that of group C,and the ISI score in group G was lower than that of group C(P<0.05).The incidence of postoperative nausea and vomiting in group G was lower than that in group C,the time of first bowel sound,first exhaust and defecation were shorter in group G than those in group C(P<0.05).Conclusion In the patients undergoing laparoscopic gynecological surgery,the GDFT strategy based on SVV and CI can effectively maintain the hemodynamic stability,reduce the incidence of postoperative nausea and vomiting,promote the recovery of postoperative gastrointestinal function,and improve the early postoperative sleep and recovery quality.

Goal-directed fluid therapyLaparoscopyRecovery quality

胡颖婷、许辉、郑晓静、疏树华

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230001 安徽合肥,安徽医科大学附属省立医院麻醉科

目标导向液体治疗 腹腔镜 恢复质量

安徽省学术和技术带头人科研活动经费资助项目

2017D147

2024

江苏医药
江苏省人民医院(南京医科大学第一附属医院)

江苏医药

影响因子:0.707
ISSN:0253-3685
年,卷(期):2024.50(6)