应用FloTrac/Vigileo监测系统行目标指导液体治疗对肝癌切除术患者围术期容量治疗效应

Effects of Goal-directed Fluid Therapy by the FloTrac/Vigileo System in Patients Undergoing Hepatoma Surgery

    摘要
  • 摘要:
      目的  应用FloTrac/Vigileo监测系统行目标指导液体治疗对肝癌切除手术患者围手术期容量治疗效应。
      方法  行择期肝癌切除术患者80例, 每组40例, 随机分为2组: 常规补液组(N组), 目标管理补液组(G组)。患者入室监测ECG、HR、SPO2、MAP、CVP。G组桡动脉连接FloTrac/Vigileo监测系统监测SVV、CI等指标。N组行常规补液治疗, G组根据SVV、CVP、CI指导行目标指导液体治疗。记录手术时间、晶体液与胶体液总量、尿量。记录术中MAP、HR、CVP、CI、SVV的变化。检测诱导后即刻、术毕时氧供量、氧耗量与氧摄取率。
      结果  与N组比较, G组晶体液输注量减少, 胶体液输注量和尿量增加(P < 0.05)。两组患者MAP、CVP、CI诱导即刻均较基础值下降, G组患者各项指标均较N组患者恢复时间早。N组患者至肝门阻断时, SVV为10.8%, 后逐渐低于10%;G组至术毕, SVV低于基础水平。术毕N组VO2、ERO2降低, G组DO2、VO2、ERO2升高(P < 0.05)且高于N组(P < 0.05)。
      结论  应用FloTrac/Vigileo监测系统行目标指导液体治疗, 可实时监测并有效地维持肝癌切除术患者术中血流动力学稳定, 保证充分的组织灌注与氧供、氧耗, 其容量治疗效应优于常规补液。

     

    Abstract:
      Objective  This study aimed to evaluate the effects of goal-directed fluid therapy by the FloTrac/Vigileo system in patients undergoing hepatoma surgery and to find the best fluid therapy.
      Methods  Eighty hepatocellular carcinoma patients were included and randomly divided into two groups based on treatment: conventional fluid therapy (group N) and goal-directed fluid therapy (group G). The vital signs of all patients were routinely monitored, including the electrocardiogram, heart rate (HR), saturation of peripheral oxygen, mean arterial pressure (MAP), and central venous pressure (CVP). In group G, the FloTrac/Vigileo system was used to obtain the stroke volume variation (SVV) and cardiac index (CI). As aforementioned, group N received conventional fluid therapy, whereas group G received fluid therapy based on the SVV, CVP, and CI. The duration of surgery, crystalloid requirements, colloid requirements, and urinary output were recorded. MAP, HR, CVP, CI, and SVV were recorded during the surgery. The oxygen delivery (DO2), oxygen consumption (VO2), and oxygen extraction ratio (ERO2) were examined after anesthesia induction and at the end of the surgery.
      Results  The crystal volume in group N was higher than that in group G (P < 0.05).The colloid number and amount of urine in group G was higher than that in group N (P < 0.05). The MAP, CVP, and CI after anesthesia induction were lower than that upon arrival at the operating room. The MAP, CVP, and CI in group G recovered to normal earlier than those in group N. The SVV was 10.8% at the moment of porta hepatic blockage in group N, and then became lower than normal thereafter. From the beginning to the end of surgery, the SVV in group G was lower than normal. The VO2 and ERO2 at the end of the surgery was lower than that upon anesthesia induction in group N, and higher than that upon anesthesia induction in group G (P < 0.05). The DO2, VO2, and ERO2 at the end of the surgery in group G was higher than those in group N (P < 0.05).
      Conclusion  Goal-directed fluid therapy by the FloTrac/Vigileo system enables real-time and effective monitoring, maintains hemodynamic stability, as well as ensures adequate tissue perfusion and optimal DO2 and VO2. This treatment method is more effective than conventional fluid therapy.

     

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