目标导向液体治疗对老年单肺通气患者局部 脑氧饱和度及血流动力学的影响

Effect of target-directed fluid therapy on regional cerebral oxygen saturation and hemodynamics in elderly patients with single-lung ventilation

摘要:

目的 探究目标导向液体治疗对老年单肺通气患者局部脑氧饱和度及血流动力学的影响。 方法 选取2017 年3 月—2018 年3 月义乌市中心医院收治的老年单肺通气患者100 例作为研究对象，将其 随机分为A、B 组，每组50 例。A 组采用常规液体，B 组采用目标导向液体，观察两组治疗效果。结果 B 组 总输液量、尿量、晶体液用量和去甲肾上腺素使用率均少于A 组（P <0.05），但是胶体液用量多于A 组 （P <0.05）。两组出血量比较，差异无统计学意义（P >0.05）。B 组拔管时间为（126.25±10.48）min，少于A 组的（158.52±10.06）min（P <0.05）。B 组血乳酸、尿酸和血肌酐水平低于A 组（P <0.05）。两组在入室桡 动脉连接监测系统时、单肺通气45 min、拔管后5 min 的HR、MAP、CVP、SVV 和rSO2 比较，采用重复测 量设计的方差分析，结果不同时间、组间、两组变化趋势有差异（P <0.05）。B 组rSO2 和rSO2min 高于A 组， 而rSO2%max 低于A 组（P <0.05）。结论 对老年单肺通气患者采用目标导向液体治疗，有助于缩短拔管时间， 且不会对患者单肺通气期间的血流动力学造成过大的影响，促使脑氧供维持在平衡状态。

Abstract:

Objective To investigate the effects of target-directed fluid therapy on regional cerebral oxygen saturation and hemodynamics in elderly patients with single-lung ventilation. Methods One hundred patients with single-lung ventilation in our hospital from March 2017 to March 2018 were enrolled as subjects. They were randomly divided into two groups. Group A used conventional fluid and Group B used target-directed fluid. The therapeutic effects of the two groups of patients were observed. Results The total infusion volume, urine volume, the requirement of crystalloid and norepinephrine of group B were all less than those of group A (P < 0.05), while the requirement of colloid was more than that of group A (P < 0.05). There was no significant difference in bleeding volume between the two groups (P > 0.05). The extubation time of group B was 126.25±10.48 min, which was lower than that of group A (158.52±10.06 min). After treatment, the serum lactate, uric acid and creatinine levels of the patients in group B were lower than those of patients in group A (P < 0.05). Analysis of variance for repeated measures showed that there were statistical differences of CVP, MAP, SVV, HR between group A and group B (P < 0.05). The rSO2 and rSO2 values of patients in group B were higher than those of patients in group A, while rSO2%max was lower than that of patients in group B (P < 0.05). Conclusion In elderly single with single-lung ventilation, the use of target-directed fluids in the treatment can help shorten the extubation time, and will not have an excessive impact on the hemodynamics during the non-ventilation period, and promote the supply of cerebral oxygen in equilibrium.