上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (1): 73-.doi: 10.3969/j.issn.1674-8115.2019.01.014

• 论著·临床研究 • 上一篇    下一篇

麻醉诱导期急性超容量液体填充对达芬奇辅助胰腺手术患者术中血流动力学的影响

钱扬，罗艳   

  1. 上海交通大学医学院附属瑞金医院麻醉科，上海 200025
  • 出版日期:2019-01-28 发布日期:2019-02-27
  • 通讯作者: 罗艳，电子信箱：ly11087@rjh.com.cn。
  • 作者简介:钱扬（1991—），女，住院医师，硕士；电子信箱：qy12144@rjh.com.cn。

Effect of acute hypervolemic fluid infusion during anesthesia induction on intraoperative hemodynamics in the patients undergoing Da Vinci robot-assisted pancreatic surgery

QIAN Yang, LUO Yan   

  1. Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2019-01-28 Published:2019-02-27

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摘要： 目的 ·探讨麻醉诱导期急性超容量液体填充（ acute hypervolemic fluid infusion，AHFI）对达芬奇辅助胰腺手术患者术中血流动力学的影响。方法 ·选择行达芬奇辅助胰腺手术患者 60例，随机分为常规输液组（对照组， n30）和 AHFI组（n30）。AHFI组于麻醉诱导前输注晶体溶液 12.5 mL/kg，诱导后至气腹前输注胶体溶液 12.5 mL/kg，气腹后按晶胶比例 1:1持续输注 8 mL/(kg · h)；对照组术中行常规液体管理。记录 2组在不同时间点的平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）、中心静脉压（central venous pressure，CVP）、心脏指数（cardiac index，CI）、每搏变异度（stroke volume variation，SVV），以及不良事件的发生次数。术后随访 2组患者的排气时间、住院时间及 3个月死亡率。结果 ·与对照组比较， AHFI组晶体使用量、胶体使用量和晶胶使用总量均显著增加（均 P<0.05），而不良事件发生次数显著降低（ P0.020）。2组患者术中的 MAP变异率、 HR变异率和 CI差异均无统计学意义（均 P>0.05）；而在气腹前、气腹后及体位改变后 AHFI组与对照组比较 CVP显著升高， SVV显著降低（均 P<0.05）。2组患者的排气时间、住院时间及 3个月死亡率差异均无统计学意义（均 P>0.05）。结论 ·诱导期 AHFI相比于常规补液方式，能减少达芬奇辅助胰腺手术患者术中不良事件的发生次数；2种方式在患者胃肠道功能恢复以及预后方面无明显差异。

关键词: 急性超容量液体填充, 达芬奇辅助胰腺手术, 血流动力学, 不良事件

Abstract:

Objective · To investigate the effect of acute hypervolemic fluid infusion (AHFI) during induction of general anesthesia on intraoperative hemodynamic fluctuation in the patients undergoing pancreatic robotic surgery. Methods · Sixty patients undergoing Da Vinci robot-assisted pancreatic surgery were randomly divided into routine infusion group (control group, n30) and AHFI group (n30). In AHFI group, the patients were infused with 12.5 mL/kg crystalloid solution before anesthesia induction, 12.5 mL/kg colloidal solution before pneumoperitoneum, and 8 mL/(kg·h) (crystalloid solution:colloidal solution1:1) continuously after pneumoperitoneum. The patients in control group were treated with routine liquid therapy. The mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume variation (SVV), and the incidence of adverse events in both groups were recorded. After operation, the exhaust time, hospitalization time and 3-month mortality of the two groups were followed up. Results · Compared with control group, the consumption of crystalloid solution, colloidal solution and both solutions in AHFI group increased (P<0.05), while the incidence of adverse events was less (P0.020). There was no significant difference in the MAP variation, HR variation and CI between the two groups (P>0.05). Compared with control group, CVP increased significantly and SVV decreased significantly in AHFI group before pneumoperitoneum, after pneumoperitoneum and after postural changes (P<0.05). There was no significant difference in the exhaust time, hospitalization time and 3-month mortality between the two groups (P>0.05). Conclusion · Compared with conventional fluid infusion, AHFI during anesthesia induction can reduce the occurrence of adverse events in the patients undergoing Da Vinci robot-assisted pancreatic surgery. There is no significant difference in the recovery of gastrointestinal function and prognosis between the two methods.

Key words: acute hypervolemic fluid infusion (AHFI), Da Vinci robot-assisted pancreatic surgery, hemodynamics, adverse event

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