检索历史 清除

目的 比较中心静脉氧饱和度(ScvO2)和中心静脉-动脉二氧化碳分压差(P(cv-a)CO2)指导的液体治疗对开腹胃肠道手术患者的影响.方法 2012年6月至2013年4月期间在浙江大学医学院附属第一医院麻醉科行择期开腹胃肠道手术且美国医师协会(ASA)分级Ⅰ-Ⅱ级患者40例,经医院伦理委员会通过,采用随机数字表法随机分为ScvO2指导输液组(S组)及P(cv-a) CO2指导输液组(P组),每组20例.所有患者术前禁食12h、禁水4h,麻醉诱导前给予乳酸林格氏液10 ml/kg,术中乳酸林格氏液2 ml · kg-1·h-1持续静滴,并根据ScvO2和P(cv-a) CO2输注人工胶体(free flex 6％HES 130/0.4),S组患者ScvO2 ＜75％或P组患者P(cv-a) CO2≥6 mm Hg(1 mm Hg=0.133 kPa)时给予6％ HES 130/0.4.手术开始切皮后每20 min进行血气分析,检测患者动静脉血乳酸水平评价组织灌注情况,并记录术后首次肛门排气时间、28 d的并发症发生率和死亡率.结果 两组患者术中T4时间点(手术开始后80 min)和T5时间点(手术开始后100 min)的血乳酸值差异有统计学意义(P值分别为0.013和0.044),其他时间点的动、静脉血血乳酸值差异无统计学意义(P＞0.05).患者术后首次肛门排气时间差异无统计学意义(P =0.673),两组患者都未发生明显并发症和死亡.结论 开腹胃肠道手术中,与ScvO2指导输液相比,P(cv-a) CO2指导的输液治疗对组织灌注有一过性的提高,但是,两者对患者胃肠道功能恢复及预后的影响无明显临床差异.

Objective To investigate the effect of central venous blood oxygen saturation (ScvO2) and venous-arterial PCO2 (P (cv-a)CO2)guided fluid therapy on tissue perfusion,gastrointestinal function recovering and outcome of the patients who undergoing open gastrointestinal surgery.Methods Forty patients undergoing open gastrointestinal surgery were randomly divided into 2 groups (n =20 each):ScvO2 guided fluid therapy (group S) and P (cv-a) CO2 guided fluid therapy (group P).All the patients were infused 10 ml/kg lactated Ringer's (LR) solution before anesthesia induction,they were all also given a continuous lactated Ringer's (LR) solution's infusion at the speed of 2 ml · kg-1 · h-1 during the operation.While,6％ HES 130/0.4 (free flex 6％ HES 130/0.4,Fresenius Kabi) infusion was different between the 2 groups,when the patients of group S' s central venous blood oxygen saturation ＜ 75％ or venous-arterial PCO2 in the patients of P group ≥6 mm Hg,then infused 6％ HES 130/0.4.Arterial and central venous blood gas analyses were performed every 20 minutes after skin incision,measure the venous and arterial lactate value,and record the anal exhaust time after surgery,postoperative complications and mortality in 28 days.Results Compared with group S,the arterial lactate value in T4 (after operation began 80 min) were significantly decreased in group P (P =0.013),and venous lactate value in T5 (after operation began 100 min) were also lower (P =0.044),other lactate value were not different (P ＞ 0.05).The anal exhaust time was not different between the two groups (P =0.673).All the patients were survival,and there were no obvious postoperative complications.Conclusion Compared to group S,there was a transient improvement in tissue perfusion in group P,but there were no difference in complications and mortality.