摘要
目的探讨下腔静脉塌陷指数(IVC-CI)导向补液对老年下肢静脉手术患者肺动脉压及血流动力学的影响。方法选取2019年6月至2020年6月在杭州市第三人民医院择期行下肢静脉手术的老年(60~80岁)患者60例,其中给予常规补液治疗30例,为对照组;经下腔静脉超声评估并以IVC-CI 40%为阈值导向补液治疗30例,为IVC-CI组。记录并比较两组患者入手术室时(T_(0))、麻醉诱导后5 min(T_(1))、入恢复室时(T_(2))的平均动脉压(MAP)、心率(HR)、肺动脉收缩压(PASP)和肺动脉平均压(PAMP),以及麻醉诱导后不良反应和心血管活性药物使用情况。结果两组患者各时点MAP、HR、PASP、PAMP比较,差异均有统计学意义(均P<0.05)。与对照组比较,IVC-CI组T_(1)时MAP、HR、PASP、PAMP均明显升高,T_(2)时MAP、PASP、PAMP均明显升高,差异均有统计学意义(均P<0.05)。两组患者麻醉诱导后均未出现肺水肿、严重的心动过缓、酸中毒、术后谵妄、苏醒延迟等并发症;与对照组比较,IVC-CI组低血压发生率明显降低,去氧肾上腺素、阿托品使用率亦明显降低,差异均有统计学意义(均P<0.05)。结论对于老年下肢静脉手术患者,以IVC-CI 40%为阈值导向补液可以减少麻醉诱导后低血压的发生,但术后肺动脉压明显升高。
Objective To assess the collapsible index of inferior vena cava(IVC-CI)-guided fluid infusion in elderly patients undergoing lower extremity vein surgery.Methods Sixty patients aged 60~80 yr and in Hangzhou Third People's Hospital from June 2019 to June 2020,scheduled for lower extremity vein surgery were randomly divided into two groups.Patients in control group(n=30)received routine rehydration,while patients in IVC-CI group(n=30)were evaluated by inferior vena cava ultrasound with a threshold of IVC-CI 40%to guide fluid infusion.Mean arterial pressure(MAP),heart rate(HR),pulmonary arterial systolic pressure(PASP)and pulmonary arterial mean pressure(PAMP)were recorded and compared at entering OR(T0),5 min after induction of anesthesia(T1)and entering PACU(T2)in the two groups.The adverse reactions after anesthesia induction and use of cardiovascular active drugs were also recorded and compared.Results There were significant differences in MAP,HR,PASP,PAMP between the two groups at each time point(P<0.05).Compared with the control group,MAP,HR,PASP,PAMP in IVC-CI group were significantly increased at T1(P<0.05).MAP,PASP,PAMP were significantly increased at T2(P<0.05).There were no complications such as pulmonary edema,severe bradycardia,acidosis,postoperative delirium and delayed resuscitation in both groups after anesthesia induction.Compared with the control group,the incidence of hypotension in IVC-CI group was significantly lower,the use of norepinephrine and atropine also decreased significantly(P<0.05).Conclusion For elderly patients with lower extremity vein surgery,IVC-CI guided fluid infusion with a threshold of 40%can reduce the incidence of hypotension after anesthesia induction,but the postoperative pulmonary arterial pressure is significantly increased.
作者
张华
周洁
汤婷
王星岑
冯冉冉
ZHANG Hua;ZHOU Jie;TANG Ting;WANG Xingcen;FENG Ranran(Department of Anesthesiology and Pain Management,Hangzhou Third People's Hospital,Hangzhou 310009,China)
出处
《浙江医学》
CAS
2021年第5期492-496,共5页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2020368461)。
关键词
下腔静脉塌陷指数
目标导向液体治疗
老年人
下肢静脉手术
肺动脉压
血流动力学
Collapsible index of inferior vena cava
Goal directed fluid therapy
Elderly
Lower extremity vein surgery Pulmonary artery pressure
Hemodynamics
