| 刘婷婷,赵 鸽,白瑞平,薛梦雯,刘 琳.以每搏量变异度为指导的目标导向液体治疗对肝癌手术患者血流动力学、应激反应及肝肾功能的影响[J].,2022,(22):4285-4289 |
| 以每搏量变异度为指导的目标导向液体治疗对肝癌手术患者血流动力学、应激反应及肝肾功能的影响 |
| Effects of Target Guided Fluid Therapy Guided by Stroke Volume Variability on Hemodynamics, Stress Response and Liver and Kidney Function in Patients with Liver Cancer Undergoing Surgery |
| 投稿时间：2022-05-23 修订日期：2022-06-18 |
| DOI：10.13241/j.cnki.pmb.2022.22.016 |
| 中文关键词: 每搏量变异度 中心静脉压 目标导向液体治疗 肝癌 血流动力学 应激反应 肝肾功能 |
| 英文关键词: Stroke volume variability Central venous pressure Target guided fluid therapy Liver cancer Hemodynamics Stress response Liver and kidney function |
| 基金项目:国家自然科学基金面上项目（81670572）；陕西省重点研发项目（2021SF-018） |
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| 中文摘要: |
| 摘要 目的：观察以每搏量变异度（SVV）为指导的目标导向液体治疗对肝癌手术患者血流动力学、应激反应及肝肾功能的影响。方法：选择2019年4月~2022年1月期间我院收治的肝癌手术患者98例，根据随机数字表法分为对照组[控制性低中心静脉压（CLCVP）指导的目标导向液体治疗，49例]和研究组（SVV为指导的目标导向液体治疗，49例）。对比两组临床指标、血流动力学、肝肾功能指标、应激反应、并发症发生率。结果：研究组的输液量、围术期失血量、围术期输血量少于对照组（P<0.05）。两组术后1d、术后3d谷草转氨酶（AST）、总胆红素（DBIL）、谷丙转氨酶（ALT）、血尿素氮（BUN）、肌酐（Cr）均升高后下降，且研究组的变化程度小于对照组（P<0.05）。两组手术开始（T1）~术毕（T4）时间点心率（HR）、平均动脉压（MAP）下降后升高（P<0.05），T1~T4时间点研究组HR、MAP高于对照组（P<0.05）。两组术后1 d、术后3 d皮质醇（Cor）、前列腺素E2（PGE2）均升高后下降，且研究组的变化程度小于对照组（P<0.05）。两组并发症发生率对比无差异（P>0.05）。结论：肝癌手术患者选用SVV为指导的目标导向液体治疗，可维持血流动力学稳定，减轻应激反应及肝肾功能损伤。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effect of target guided fluid therapy guided by stroke volume variability (SVV) on hemodynamics, stress response and liver and kidney function in patients with liver cancer. Methods: 98 patients with liver cancer who were treated in our hospital from April 2019 to January 2022 were selected, and they were randomly divided into control group [controlled low central venous pressure (CLCVP) target guided fluid therapy, 49 cases] and study group(SVV target guided fluid therapy, 49 cases). The changes of clinical indexes, liver and kidney function indexes, hemodynamics, stress response and perioperative complications were compared between the two groups. Results: The infusion volume, perioperative blood loss and perioperative blood transfusion volume of the study group were less than those of the control group (P<0.05). Glutamic oxaloacetic transaminase (AST), total bilirubin (DBIL), glutamic pyruvic transaminase (ALT), blood urea nitrogen (BUN) and creatinine (Cr) increased and then decreased in the two groups at 1 d after operation and 3 d after operation, and the change degree in the study group was less than that in the control group (P<0.05). The heart rate (HR) and mean arterial pressure (MAP) decreased and then increased from the beginning (T1) to the end (T4) of operation time points in the two groups (P<0.05), while HR and MAP in the study group were higher than those in the control group (P<0.05). Cortisol (Cor) and prostaglandin E2 (PGE2) increased and then decreased in the two groups at 1d after operation and 3 d after operation, and the degree of change in the study group was less than that in the control group (P<0.05). There was no difference in the incidence of complications between two groups (P>0.05). Conclusion: SVV guided target directed fluid therapy for patients with liver cancer surgery can maintain hemodynamic stability, reduce stress response and liver and kidney function damage. |
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