目标导向液体治疗优化老年腰椎手术患者术中血流动力学降低术后并发症

基础医学与临床 ›› 2021, Vol. 41 ›› Issue (2): 178-183.

目标导向液体治疗优化老年腰椎手术患者术中血流动力学降低术后并发症

夏迪, 许力^*, 李旭, 黄宇光

中国医学科学院北京协和医学院北京协和医院麻醉科, 北京 100730

收稿日期:2020-08-23 修回日期:2020-12-19 出版日期:2021-02-05 发布日期:2021-01-19
通讯作者: ^*pumchxuli@163.com
基金资助:
中国医学科学院医学与健康科技创新工程(2016-I2M-3-024)

Goal-directed fluid therapy optimizes hemodynamics on the elderly patients undergoing lumbar decompressive surgery and reduces postoperative complications

XIA Di, XU Li^*, LI Xu, HUANG Yu-guang

Department of Anesthesiology,Peking Union Medical College Hospital,CAMS & PUMC,Beijing 100730,China

Received:2020-08-23 Revised:2020-12-19 Online:2021-02-05 Published:2021-01-19
Contact: ^*pumchxuli@163.com

摘要/Abstract

摘要： 目的揭示目标导向液体治疗管理策略(GDT)影响老年腰椎手术患者围术期并发症状况。方法将择期实施腰椎手术的老年患者当做观察对象,随机分为对照组(按照现有麻醉液体治疗标准进行常规液体管理)和实验组(采用GDT策略进行术中液体管理)。观察患者术中血流动力学指标及液体使用情况、术后胃肠功能指标、术后30 d并发症发生情况,并整理相关数据。结果实验组的心输出量(CO)、心脏指数(CI)在手术结束时均明显高于对照组(P＜0.05)。在术中液体总输注量上,比照两组结果,实验组显著偏多(P＜0.05);然在血管活性药应用量上,对比结果,观察组显著偏低(P＜0.05);就应用药物辅助排便、排气人数而言,与对照组相比,实验组显著偏少(P＜0.05);在相关并发症感染发生率指标上,与对照组相比,实验组显著降低(P＜0.05)。结论 GDT能够使老年腰椎手术患者术后改善灌注,减少术后感染等相关并发症。

关键词: 目标导向液体治疗, 乳酸, 灌注, 感染

Abstract: Objective To explore the impact of goal-directed fluid therapy(GDT) management strategy on the perioperative complications of elderly patients undergoing lumbar spine surgery. Methods Elderly patients undergoing elective lumbar spine surgery were selected and randomly divided into the control group with routine fluid management according to the existing anesthetic fluid treatment standards and the experimental group for intraoperative fluid management using GDT strategies. Hemodynamic indicators, perioperative fluid, gastrointestinal function indicators and the incidence of complications in the 30 days after surgery were collected. Results Cardiac output (CO) and cardiac index (CI) of the experimental group were significantly higher than those of the control group (P＜0.05) at the end of operation. The two groups also showed a significant different(P＜0.05) in total intraoperative fluid infusion volume, which was more significant than comoparison with experimental(GDT)group. However,the dosage of vasoactive drugs was significantly lower in the observation group (P＜0.05). Compared with the observation group, the number of patients receiving medicine-assisted defecation and exhaust was significantly less than that in the experimental group (P＜0.05). Compared with the observation group, the experimental group has significantly less was complication infectio (P＜0.05). Conclusions GDT can reduce postoperative complications in elderly patients undergoing lumbar spine surgery, thereby improving the perfusion and prognosis.

Key words: goal-directed fluid therapy, lactate acid, perfusion, infection

中图分类号:

R614.2

夏迪, 许力, 李旭, 黄宇光. 目标导向液体治疗优化老年腰椎手术患者术中血流动力学降低术后并发症[J]. 基础医学与临床, 2021, 41(2): 178-183.

XIA Di, XU Li, LI Xu, HUANG Yu-guang. Goal-directed fluid therapy optimizes hemodynamics on the elderly patients undergoing lumbar decompressive surgery and reduces postoperative complications[J]. Basic & Clinical Medicine, 2021, 41(2): 178-183.

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