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目标导向液体治疗在腹腔镜胰十二指肠切除术中的临床应用
彭晓静,张辉,张树波,高晓增,刘铁军,韩小亮
0
(华北理工大学附属医院;开滦总医院)
摘要:
【摘要】目的 探讨目标导向液体治疗对胰十二指肠切除术患者肠道功能的影响。方法 选取2017年6月~2019年6月开滦总医院择期全麻下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随机分为G组和C组。G组采用目标导向液体治疗,C组采用常规补液治疗。记录两组患者术中液体出入量、血管活性药用量、手术时间、尿量、失血量、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(T0)、手术开始(T1)、标本切除时(T2)、手术结束(T3)患者的平均动脉压(MAP)、心率(HR)、心脏指数( CI) 、中心静脉压(CVP)、每搏量变异度(SVV)、乳酸(Lac)、中心静脉血氧饱和度(Scv02)等情况。在T0~T3及术后第 1、2、3 天(T4、T5、T6 )七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、脂多醣(LPS);在T0~T3抽取患者中心静脉血,测定血浆神经营养因子3(NT3)和甘丙肽(GAL)的浓度。结果 在T2 和T3时间点G组与C组相比MAP升高、 CVP下降、 SVV下降、CI增加、乳酸(Lac)降低、ScvO2升高(P<005)。与C组相比,G组胶体液入量和多巴胺使用量多,晶体液入量、输液总量少(P<005),去甲肾上腺素用量少(P<005),气管插管的拔管时间G组比C组要早。在T2~T6时,与C组相比,G组血浆DAO、D乳酸和LPS降低。术后第1天血浆DAO、D乳酸和LPS均达到峰值,之后开始下降。与T0比较, 在T1~T2时两组患者血浆NT3均升高, T3时均下降, 而G组比C组变化明显,而血浆GAL 在T2 和T3时持续升高, G组比C组变化明显。结论 在腹腔镜胰十二指肠切除术中应用目标导向液体治疗,可维持有效循环血容量及血压以保证全身灌注,改善微循环,对患者肠黏膜屏障功能和运动功能有保护作用。
关键词:  腹腔镜胰十二指肠切除术  目标导向液体治疗  每搏量变异度  心脏指数  肠黏膜功能  复合麻醉
DOI:
基金项目:河北省医学科学研究重点课题(20160740)
Clinical applications of goal directed fluid therapy in laparoscopic pancreatoduodenectomy
PENG Xiaojing,ZHANG Hui,ZHANG Shubo,GAO Xiaozeng,LIU Tiejun,HAN Xiaoliang
(The Affiliated Hospital of North China University of Technology;Kailuan General Hospital)
Abstract:
【Abstract】Objective To investigate the clinical applications of goaldirected fluid therapy for pancreatoduodenectomy and observe the effect of goald directed fluid therapy and Conventional liquid therapy on intestinal function in patients undergoing laparoscopic pancreaticoduodenectomy. Methods 60 patients undergoing pancreatoduodenectomy under general anesthesia were randomly divided into groups G and groups C. Goaldirected fluid therapy was used in Group G, whereas conventional fluid therapy was used in group C. Liquid management, dosages of vasoactive drugs, operation time, urine volume, blood loss, number of cases of concentrated red blood cell input, tracheal extubation time and hospital stay were recorded. Mean arterial pressure(MAP), heart rate(HR), cardiac index(CI), central venous pressure(CVP), stroke volume variation(SVV), lactic acid(Lac) and Central venous oxygen saturation(Scv02) of patients were recorded before anesthesia (T0), at the beginning of operation (T1), at the time of specimen excision (T2), and at the end of operation (T3). Choose seven time points,such as T0T3 and 1, 2 and 3 days (T4, T5, T6) after operation. Central venous blood was drawn and diamine Oxidase, (DAO), DLactic and lipopolysaccharide (LPS) were detected. Neurotrophin3(NT3) and galanin(GAL) were detected at the time T0T3. Results Compared with group C at T2 to T3, the MAP increased, CVP decreased, SVV decreased, CI increased, low Lac, high ScvO2(P<005). The amount of crystalloid requirements and total infusion in group G were less than that of group C (P<005). The colloidal solution and dopamine usage in group G were fewer than that of group C (P<005). The extubation time of tracheal intubation in group G was earlier than that in group C. The plasma DAO, Dlactic acid and LPS in group G were lower than those in group C at the time T2T6. The peak of DAO, Dlactic acid and LPS appeared on the first day after operation, and then began to decrease. Comparing with T0, NT3 went up at T1~T2 and decreases at T3. The change of G group was more obvious than that of C group. However, plasma GAL increased continuously at T2 and T3. Similarly, the changes in group G were more obvious than those in group C. Conclusion Goaldirected fluid therapy can maintain effective circulating blood volume and blood pressure, and can guarantee tissue perfusion. Goaldirected fluid therapy can improve microcirculation and protect intestinal mucosal barrier function and motor function.
Key words:  Laparoscopic pancreatoduodenectom  Goald directed fluid therapy  Stroke Volume Variation  Cardiac index  Intestinal mucosal function  Intravenous inhalation combined anesthesia

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