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中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 194 -198. doi: 10.3877/cma.j.issn.1674-0793.2022.03.007

论著

下腔静脉变异度为指导的围手术期容量管理在腹腔镜肝切除术中的临床应用
王莹莹1, 刘莉1,(), 吕瑞兆1, 柳洁1, 白晓明1, 井郁陌1   
  1. 1. 061001 河北省沧州中西医结合医院麻醉一科
  • 收稿日期:2022-04-13 出版日期:2022-06-01
  • 通信作者: 刘莉
  • 基金资助:
    河北省卫健委2019年度科研立项项目(20191278)

Clinical study of perioperative volume management based on variation of inferior vena cava distensibility in laparoscopic partial hepatectomy

Yingying Wang1, Li Liu1,(), Ruizhao Lyu1, Jie Liu1, Xiaoming Bai1, Yumo Jing1   

  1. 1. The First Ward of Department of Anesthesiology, Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Cangzhou 061001, China
  • Received:2022-04-13 Published:2022-06-01
  • Corresponding author: Li Liu
引用本文:

王莹莹, 刘莉, 吕瑞兆, 柳洁, 白晓明, 井郁陌. 下腔静脉变异度为指导的围手术期容量管理在腹腔镜肝切除术中的临床应用[J/OL]. 中华普通外科学文献(电子版), 2022, 16(03): 194-198.

Yingying Wang, Li Liu, Ruizhao Lyu, Jie Liu, Xiaoming Bai, Yumo Jing. Clinical study of perioperative volume management based on variation of inferior vena cava distensibility in laparoscopic partial hepatectomy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(03): 194-198.

目的

探讨基于下腔静脉变异度(dIVC)的围手术期容量管理在腹腔镜肝切除术中的临床研究。

方法

选择2019年7月至2021年3月河北省沧州中西医结合医院行腹腔镜肝切除术的64例患者,按照随机数字表法分为以dIVC为指导(dIVC组)和以中心静脉压(CVP)为指导(CVP组)围手术期容量管理,各32例。记录两组患者麻醉前(T0)、手术开始时(T1)、手术结束时(T2)、术后6 h(T3)的平均动脉压(MAP)、血氧饱和度(SPO2)、氧合指数、血乳酸等水平变化;记录两组患者术前及术后1、3、7 d的肝肾功能指标,包括谷丙氨酸(ALT)、谷草转氨酸(AST)、总胆红素(TBIL)、肌酐(Cr)、尿素氮(BUN)等水平变化;记录两组患者术后通气时间、苏醒时间及丙泊酚用量。

结果

dIVC组在T1~T3时的MAP(t=2.427、2.872、3.826,P=0.018、0.006、<0.001)、SPO2t=2.454、2.129、2.661,P=0.017、0.037、0.010)及氧合指数(t=2.961、2.095、2.946,P=0.004、0.040、0.005)均高于CVP组;在T2、T3时的血乳酸水平低于CVP组,差异均有统计学意义(t=2.263、7.845,P=0.027、<0.001)。dIVC组术后3、7 d的血清ALT水平低于CVP组(t=2.766、2.991,P=0.008、0.004),术后1、3 d的AST水平低于CVP组(t=2.894、2.482,P=0.005、0.016),术后3 d的TBIL水平低于CVP组(t=2.236,P=0.029),差异均有统计学意义;两组术后1、3、7 d的Cr(t=0.560、0.259、0.098,P=0.578、0.796、0.922)和BUN(t=0.222、0.362、0.569,P=0.825、0.718、0.572)水平差异均无统计学意义。dIVC组的术中机械通气时间和苏醒时间均少于CVP组,差异有统计学意义(t=2.828、2.599,P=0.006、0.012),两组术中丙泊酚用量、手术时间及术中输血情况比较差异均无统计学意义(t=1.928、0.417、0.110,P=0.058、0.678、0.740)。

结论

基于dIVC的容量管理在腹腔镜肝切除术中可维持血流动力学稳定,改善组织氧供,减少肝功能损伤。

Objective

To investigate the clinical study of perioperative volume management based on inferior vena cava distensibility (dIVC) in laparoscopic partial hepatectomy.

Methods

A total of 64 patients who underwent laparoscopic hepatectomy in Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from July 2019 to March 2021 were selected and divided into dIVC group (following vena cava variation as guideline) and CVP group (following central venous pressure as guideline) according to the random number table method, with 32 cases in each group. The changes of mean arterial pressure (MAP), blood oxygen saturation (SPO2), oxygenation index and blood lactic acid were recorded before anesthesia (T0), at the beginning of surgery (T1), at the end of surgery (T2) and 6 h after operation (T3) in the two groups. Liver and kidney function indexes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), creatinine (Cr) and urea nitrogen (BUN) in both groups were recorded before and 1, 3 and 5 days after operation. Postoperative ventilation time, recovery time and dosage of propofol were recorded.

Results

MAP (t=2.427, 2.872, 3.826, P=0.018, 0.006, <0.001), SPO2 (t=2.454, 2.129, 2.661, P=0.017, 0.037, 0.010) and oxygenation index (t=2.961, 2.095, 2.946, P=0.004, 0.040, 0.005) of dIVC group from T1 to T3 were higher than those of CVP group, with statistical significances. The blood lactic acid level of dIVC group at T2 and T3 was lower than that of CVP group, with statistical significances (t=2.263, 7.845, P=0.027, <0.001). The serum level of ALT (t=2.766, 2.991, P=0.008, 0.004) of dIVC group was lower than that of CVP group on day 3 and 7 after surgery, AST (t=2.894, 2.482, P=0.005, 0.016) of dIVC group was lower than that of CVP group on day 1 and 3 after surgery, and TBIL (t=2.236, P=0.029) level of dIVC group was lower than that of CVP group on day 3 after surgery, with statistical significances. There were no significant differences in the levels of Cr (t=0.560, 0.259, 0.098, P=0.578, 0.796, 0.922) and BUN (t=0.222, 0.362, 0.569, P=0.825, 0.718, 0.572) between the two groups after operation. The duration of intraoperative mechanical ventilation and recovery time of dIVC group were both shorter than those of CVP group, with statistically significant differences (t=2.828, 2.599, P=0.006, 0.012), while there were no statistically significant differences in intraoperative propofol dosage, operation time and intraoperative blood transfusion between the two groups (t=1.928, 0.417, 0.110, P=0.058, 0.678, 0.740).

Conclusion

Volume management based on variation of dIVC can maintain hemodynamic stability, improve microcirculation perfusion, improve tissue oxygen supply and reduce liver function injury.

表1 两组腹腔镜肝切除术患者一般资料比较
表2 两组腹腔镜肝切除术患者血流动力学及血液化学参数比较(±s)
表3 两组腹腔镜肝切除术患者术前及术后肝肾功能比较(±s)
表4 两组腹腔镜肝切除术患者围手术期相关指标比较
[1]
高宪, 黄艰, 杨贞, 等. 小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响[J]. 第三军医大学学报, 2019, 41(21): 2114-2119.
[2]
中国医师协会外科医师分会微创外科医师委员会. 腹腔镜肝切除术加速康复外科中国专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(5): 517-524.
[3]
田亚丽, 李冰冰. 围手术期患者容量状态评估及液体管理研究进展[J]. 国际麻醉学与复苏杂志, 2019, 40(8): 774-779.
[4]
Long E, Oakley E, Duke T, et al. Does respiratory variation in inferior vena cava diameter predict fluid responsiveness: A systematic review and Meta-analysis[J]. Shock, 2017, 47(5): 550-559.
[5]
燕喜娇, 张文凯, 侯林义. 超声测定下腔静脉内径变异度在围术期容量评估及治疗中的应用[J]. 中国实用医刊, 2019, 46(18): 45-47.
[6]
段纷雨, 赵志斌, 张小宝, 等. 下腔静脉扩张指数指导液体管理改善经尿道前列腺切除术患者早期预后[J]. 临床麻醉学杂志, 2021, 37(5): 484-488.
[7]
王会娟, 贾彤, 李树铁, 等. 超声测量下腔静脉呼吸变异指数评估机械通气脓毒症休克患者容量反应性[J]. 山西医科大学学报, 2016, 47(6): 551-555.
[8]
Cherpanath TG, Geerts BF, Maas JJ, et al. Ventilator-induced central venous pressure variation can predict fluid responsiveness in post-operative cardiac surgery patients[J]. Acta Anaesthesiol Scand, 2016, 60(10): 1395-1403.
[9]
叶先钦, 许伟珍, 莫建伟, 等. 超声测量下腔静脉变异度在颅脑术后合并急性呼吸窘迫综合征患者液体管理中的临床应用分析[J]. 中国医学创新, 2017, 14(29): 41-44.
[10]
Achar SK, Sagar MS, Shetty R, et al. Respiratory variation in aortic flow peak velocity and inferior vena cava distensibility as indices of fluid responsiveness in anaesthetised and mechanically ventilated children[J]. Indian J Anaesth, 2016, 60(2): 121-126.
[11]
Pişkin Ö, Öz İİ. Accuracy of pleth variability index compared with inferior vena cava diameter to predict fluid responsiveness in mechanically ventilated patients[J]. Medicine (Baltimore), 2017, 96(47): e8889.
[12]
Corl KA, George NR, Romanoff J, et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients[J]. J Crit Care, 2017, 41: 130-137.
[13]
梁伟军, 谭洪毅, 谢和宾, 等. 超声指导下液体管理对急性呼吸窘迫综合征患者预后影响的研究[J]. 临床肺科杂志, 2019, 24(4): 680-684.
[14]
申盛乾, 段小辉, 刘苏来, 等. 目标导向液体治疗在老年患者开腹肝切除术中的应用[J]. 中国普通外科杂志, 2019, 28(1): 77-83.
[15]
孟改革, 方卫平, 张雷, 等. 目标导向液体治疗下晶体液与胶体液输注对肝切除术患者组织灌注和术后恢复的影响[J]. 临床麻醉学杂志, 2017, 33(6): 557-561.
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