广东医学2018，Vol.39Issue(9)：1279-1282,4.
目标导向液体治疗在胃肠外科ERAS术中容量管理的应用
GDFT on fluid management in patients undergoing laparoscopic colorectal resection with an ERAS program
摘要
Abstract
Objective To investigate the effect of goal -directed fluid therapy (GDFT) on fluid management in patients undergoing laparoscopic colorectal resection with an enhanced recovery after surgery (ERAS) program.Methods Thirty-two patients undergoing laparoscopic colorectal resection ,were received monitor with Vigileo .cardiac output. The hemodynamic parameters including cardiac index (CI),stroke volume(SV) and stroke volume variation(SVV) were used to guide fluid therapy.The variation of mean arterial pressure (MAP)、heart rate (HR)、CO、CI、SV and SVV at the different time points including after anesthesia induction (T1),beginning of surgery (T2),one hour after pneumoperitone-um (T3),five minutes after laparotomy (T4) and the end of the surgery(T5) were recorded.The total volume of fluid in-cluding crystalloid and colloid , blood loss, urine output, requirement for vasoactive agents during operation were recor-ded.Visual Analogue Scale , Ramsay Sedation Score, recovery and operation -related complications after operation were recorded.Results MAP at time points T2～T5 were higher than that at T1 time point(P＜0.05),CO at T2 and T3 were lower than that at T4 and T5 (P＜0.05),while SV at T3～T5 were higher(P＜0.05).HR、CI at T1、T3～T5 was higher than that at T2(P＜0.05).SVV at T1、T2、T4、T5 were lower than that at T3(P＜0.05),while CO、SV at T4 and T5 were higher(P＜0.05).56%of patients used vasoactive agents during the operations , bleeding volume(81.87±41.48)mL, urine volume(294.37±210.33)mL, total volume of fluid infused (1 129.68±227.04)mL;the length of hospital stay af-ter operation(4.6±2.17) d. Conclusion GDFT based on ERAS program applied to patients undergoing laparoscopic can significantly promote fluid management and postoperative rehabilitation .Noting the influence of the pneumoperitoneum and patients position on the parameters of GDFT during the operations .关键词
加速康复外科/目标导向液体治疗/每搏量变异度/心脏指数/气腹/补液量/血管活性药物Key words
enhanced recovery after surgery/goal-directed fluid thearpy/stroke volume variation/cardiac in-dex/pneumoperitoneum/total volume of fluid infused/vasoactive agents引用本文复制引用
王翔,周婷,方嘉凯,梁启波,许睿,张鸿飞,徐世元,雷洪伊..目标导向液体治疗在胃肠外科ERAS术中容量管理的应用[J].广东医学,2018,39(9):1279-1282,4.基金项目
广东省自然科学基金资助项目(编号:2015A030313296) （编号:2015A030313296）
