下腔静脉扩张指数指导目标导...膝关节置换术后并发症的影响_彭晶.pdf

临床研究下腔静脉扩张指数指导目标导向液体治疗对老年患者全膝关节置换术后并发症的影响彭晶王骜章放香马熠曾德亮何福娟秦晨光黄玲DOI:1012089/jca202302003基金项目:贵州省卫生健康委科学技术基金项目(gzwkj2022 126);贵州省人民医院青年基金(GZSYQN2018 13 号，GZSYQN 2019 20 号)作者单位:550002贵阳市，贵州省人民医院麻醉科通信作者:章放香，Email:zfx1205 126com【摘要】目的探讨下腔静脉扩张指数(IVC-DI)指导的目标导向液体治疗(GDFT)对老年患者全膝关节置换术术后并发症的影响。方法选择 2019 年 3 月到 2021 年 8 月行全膝关节置换术的老年患者 120 例，男 29 例，女 91 例，年龄 6585 岁，BMI 1830 kg/m2，ASA 级。采用随机分组法分为三组:经胸 IVC-DI 监测组(I 组)、每搏量变异度(SVV)监测组(S 组)和血压监测组(C 组)，每组 40 例。I 组 IVC-DI18%时，补充胶体液 250 ml;若 IVC-DI18%，而 MAP 低于基础值的 80%，给予升压药物。S 组 SVV13%时，补充胶体液 250 ml;若 SVV13%，而 MAP 低于基础值的 80%，给予升压药物。C 组 MAP 低于基础值的 80%时，补充胶体液 250 ml，当胶体液量达 20 ml/kg 时血压仍未改善，给予升压药物。记录麻醉药物用量、出血量、晶体和胶体输注量、总输注量、升压药物使用和输血情况。记录术后 6 h、1、2、3 d 活动(抬腿屈膝)时 VAS 疼痛评分。记录手术时间、术后首次下床活动时间、首次肛门排气时间、术后 48 h 内镇痛泵总按压次数和有效按压次数、恶心呕吐、切口感染、入 ICU 情况、术后住院时间。记录术后 30 d 并发症发生情况。结果与 C 组比较，I 组和 S 组晶体输注量明显增多(P005)，胶体输注量和总输注量明显减少(P0.05)，升压药物使用率明显升高(P0.05)。与术后 6 h 比较，术后 1、2、3 d 三组活动时 VAS 疼痛评分明显升高(P0.05)。与 I 组比较，术后 3 d S 组和 C 组活动时 VAS 疼痛评分明显升高(P0.05)。与 C 组比较，I 组和 S 组术后首次肛门排气时间明显缩短(P0.05)，总并发症发生率明显降低(P0.05)。三组手术时间、术后首次下床活动时间、镇痛泵总按压次数和有效按压次数、恶心呕吐、切口感染、入 ICU 率、术后住院时间、术后 30 d 并发症发生率差异无统计学意义。结论与常规监测比较，IVC-DI 指导目标导向液体治疗可通过减少术后并发症加快老年患者全膝关节置换术后康复。【关键词】目标导向液体治疗;下腔静脉扩张指数;每搏量变异度;膝关节置换术;术后并发症Effect ofgoal-directedfluidtherapyguidedbyinferiorvenacavadistensibilityindexonpostoperative complications in elderly patients undergoing total knee replacementPENG Jing，WANG Ao，ZHANG Fangxiang，MA Yi，ZENG Deliang，HE Fujuan，QIN Chenguang，HUANG LingDepartment of Anesthesiology，Guizhou Provincial People s Hospital，Guiyang 550002，ChinaCorresponding author:ZHANG Fangxiang，Email:zfx1205 126com【Abstract】ObjectiveTo investigate the effect of goal-directed fluid therapy(GDFT)guided bythe inferior vena cava distensibility index(IVC-DI)on the postoperative complications in elderly patientsundergoing total knee replacement MethodsA total of 120 patients underwent total knee arthroplasty fromMarch 2019 to August 2021，29 males and 91 females，aged 6585 years，BMI 1830 kg/m2，ASA physi-cal status，were randomly divided into three groups:fluid therapy guided by transthoracic IVC-DImonitoring(group I)，stroke volume variation monitoring(group S)，and blood pressure monitoring(groupC)，40 patients in each group Patients in group I were treated with colloid solution 250 ml when IVC-DI 18%，if IVC-DI 18%and MAP less than 80%of the basal blood pressure，vasopressors were given Pa-tients in group S were treated with colloid solution 250 ml when SVV 13%，if SVV 13%and MAP lessthan 80%of the basal blood pressure，vasopressors were given Patients in group C were treated with colloidsolution 250 ml when MAP less than 80%of the basal blood pressure and repeated until MAP more than80%of the baseline If it was not improved when the colloid volume reached 20 ml/kg，vasopressors was ad-ministered until MAP more than 80%of the baseline Anesthetic drug dosage，bleeding volume，crystal andcolloidal infusion，total infusion volume，vasopressor drug use，and blood transfusion were recorded The421临床麻醉学杂志 2023 年 2 月第 39 卷第 2 期J Clin Anesthesiol，February 2023，Vol39，No2VAS pain score was recorded 6 hours，1，2，and 3 days after surgery(leg lift and knee flexion)The timeof operation，the first time of getting out of bed，the first time of exhaust，the total number of analgesiapump compressions and effective compressions within 48 hours after surgery，nausea and vomiting，incisioninfection，ICU admission，and postoperative hospital stay were recorded The occurrence of complications ineach system was followed up and recorded 30 days after surgery esultsCompared with group C，thecrystal infusion volume in groups I and S was significantly increased(P 0.05)，colloid infusion volumeand total infusion volume were significantly decreased(P 0.05)，and the utilization rate of vasopressordrugs was significantly increased(P 0.05)Compared with 6 hours after surgery，the VAS pain scores inthree groups 1，2 and 3 days after surgery were significantly increased(P 0.05)Compared with group I，the VAS pain scores in groups S and C were significantly increased 3 days after surgery(P 0.05)Com-pared with group C，groups I and S had significantly shorter time for first exhaust(P 0.05)，the totalcomplication rate was significantly reduced(P 0.05)There were no significant differences in the opera-tion time，the first time to get out of bed，the total and effective times of analgesic pump compressions，nau-sea and vomiting，incision infection，ICU admission，postoperative hospital stay，and complications 30 daysafter surgery among the three groups ConclusionCompared with routine monitoring，goal-directed fluidtherapy of IVC-DI can accelerate the rehabilitation of elderly patients after knee arthroplasty by reducingpostoperative complications【Key words】Goal-oriented fluid therapy;Inferior vena cava distensibility index;Stroke volume var-iation;Knee replacement;Postoperative complications围术期液体治疗是临床麻醉的重要内容，液体输注量过多或过少均会对患者的术后康复产生不良影 响1。近 年 来，目 标 导 向 液 体 治 疗(goal-directed fluid therapy，GDFT)成为常用的围术期液体治疗方法。全膝关节置换术的患者主要以高龄、合并多器官系统疾病为主，手术和