目的 探讨每搏量变异(stroke volume variation,SVV)在急性非等容血液稀释中的应用价值。方法 选择2017年3-12月行全麻下择期脊柱手术的患者60例,随机分为观察组和对照组,每组30例;观察组以SVV作为采血时血流动力学监测指标,对照组以平均动脉压(MAP)和心率(HR)作为采血时血流动力学监测指标。全麻后行急性非等容血液稀释,分别于采血前即刻(T0)、采血100 ml时(T1)、采血200 ml时(T2)、采血300 ml时(T3)、采血结束时(T4)5个时间点记录两组患者MAP、HR或SVV;观察各采血时间点Hct及Hb数值;记录每位患者的采血时间、采血量、采血结束时的羟乙基淀粉(HES)用量及尿量。结果 (1)观察组:与T0相比,T1、T2时点MAP及HR差异无统计学意义,T3、T4 MAP及HR时点差异有统计学意义(P＜0.05)。与T0相比,T1～T3时点SVV差异无统计学意义,T4时点SVV[(9.8±1.2)%]显著高于T0时点SVV[(5.5±1.3)%],差异有统计学意义(P＜0.05)。(2)对照组:T1和T0时点相比,MAP及HR差异无统计学意义;T2-T4时点MAP显著低于T0时点,HR显著高于T0时点(P＜0.05)。与对照组相比,观察组T2-T4时点MAP及HR差异有统计学意义(P＜0.05)。T0及T1时点两组Hb及Hct差异无统计学意义,T2-T4时点观察组Hb及Hct显著低于对照组(P＜0.05)。观察组平均采血量[(396±91)ml]显著高于对照组[(357±86)ml],HES用量观察组显著高于对照组(P＜0.05)。两组采血时间、尿量差异无统计学意义。结论 术中行急性非等容血液稀释时,SVV作为血流动力学监测指标,比MAP和HR能更好地维持循环动力学稳定,对急性非等容血液稀释的安全实施具有较好的指导作用。
Abstract
Objective To investigate the applicability of stroke volume variation(SVV) in acute non-normovolemic hemodilution. Methods Sixty patients were enrolled in this study who were scheduled to receive elective surgery at our hospital between March 2017 and December 2017 under general anesthesia. They were randomly divided into the control group (group C) and the observation group (group O), with 30 cases in each group. MAP, HR, SVV, hemoglobin(Hb) and hematocrit (Hct) of the two groups were recorded before blood collection (T0), upon the collection of 100 ml of blood (T1), 200 ml of blood (T2), 300 ml of blood (T3) and at the end of blood collection(T4) respectively, so were the duration of blood collection, total colloid collection and the urine volume. Results The levels of SVV[(9.8±1.2)%] at T4 were higher than at T0[(5.5±1.3)%] (P＜0.05) in group O, but there was no significant difference between T0,T1 and T3. The levels of MAP at T2-T4 were lower than at T0 while the levels of HR at T2-T4 were higher than at T0 (P＜0.05) in group C, but there was no significant difference between T0 and T1. The levels of Hb and HCT in group O were significantly lower than those in group C, while the total volume of blood collection and colloid collection in group O were significantly higher than those in group C(P＜0.05). Conclusions SVV monitoring can better maintain hemodynamic stability than MAP and HR, which is more conductive to acute non-normovolemic hemodilution during surgery.
关键词
每搏量变异 /
急性非等容血液稀释 /
血流动力学 /
羟乙基淀粉
Key words
stroke volume variation /
acute non-normovolemic hemodilution /
hemodynamics /
hydroxyethyl starch
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基金
海军总医院创新培育基金(CXPY201724)
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