不同每搏变异度指导下的目标导向液体治疗对肝癌手术患者术后肝肾功能的影响

肝癌电子杂志 ›› 2020, Vol. 7 ›› Issue (3): 12-16.

不同每搏变异度指导下的目标导向液体治疗对肝癌手术患者术后肝肾功能的影响

刘超, 邹亮^*, 郑晖

国家癌症中心/国家肿瘤临床研究中心/中国医学科学院北京协和医学院肿瘤医院麻醉科,北京 100021

收稿日期:2020-03-02 发布日期:2020-10-22
通讯作者: *邹亮E-mail:zouliang2001@163.com
作者简介:邹亮,主任医师,中国医学科学院北京协和医学院肿瘤医院,麻醉科
基金资助:
中国癌症基金会北京希望马拉松专项基金（LC2017A22）

Effects of stroke volume variation guided goal-directed fluid therapy on liver and renal function of patients after liver cancer surgery

Liu Chao, Zou Liang^*, Zheng Hui

Department of Anaesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received:2020-03-02 Published:2020-10-22

摘要/Abstract

摘要： 目的探讨不同每搏量变异度（stroke volume variation, SVV）指导的目标导向液体治疗(goal-directed fluid therapy, GDFT)对肝癌手术患者术后肝肾功能的影响。方法选取60例中国医学科学院北京协和医学院肿瘤医院行择期肝脏手术的肝癌患者,随机分为低SVV组（1<SVV≤5）和高SVV组（5<SVV≤9）。两组均恒速缓慢输注乳酸林格液补充生理需要量,若SVV高于分组阈值（低SVV组> 5,高SVV组> 9）,则在15min内给予250ml羟乙基淀粉快速输注,观察SVV变化;若SVV仍高于分组阈值,重复给予,直至SVV回落至分组阈值内。记录术中出入量、手术时间、术后3d内谷草转氨酶、谷丙转氨酶、活化部分凝血活酶时间、血肌酐、血尿素氮等肝肾功能指标。结果术中胶体用量低SVV组显著高于高SVV组[900（425）ml比500（525）ml,P<0.05],术中液体总入量低SVV组显著高于高SVV组 [（2340.0±856.5）ml比（1885.0±730.4）ml,P<0.05],出血量、尿量两组患者间无显著性差异,两组患者血清AST、ALT、APTT水平,以及Cr、BUN水平,在术后1d、术后2d、术后3d差异无统计学意义。结论基于SVV指导的目标导向液体治疗,将有利于术中限制液体输入量,且对术后肝肾功能无影响,利于肝癌术中液体管理。

关键词: 每搏量变异度, 目标导向液体治疗, 肝癌手术, 肝肾功能

Abstract: Objective: To investigate the effect of stroke volume variation (SVV) guided goal-directed fluid therapy (GDFT) on liver and renal function of patients after liver cancer surgeries. Methods: Sixty patients undergoing liver cancer surgeries in cancer hospital of Chinese academy of medical sciences were randomly divided into a low SVV group (1<SVV≤5) and a high SVV group (5<SVV≤9). In both groups, doses of ringer lactate were infused slowly at a steady speed. If SVV was higher than the threshold (SVV>5 in the low SVV group and SVV>9 in the high SVV group), a dose of 250ml hydroxyethyl starch 130/0.4 was given within 15 minutes to observe the changes of SVV. If SVV is still higher than the threshold, such dose was repeatedly given until SVV readings fall below the threshold. Records of fluid intake and output during operation, as well as operation time are done and kept, besides AST, ALT, APTT, Cr, BUN and other liver and renal function indicators within 3 days post-surgery. Results: The amount of fluid input was significantly reduced in the high SVV group, and there was no statistical difference in postoperative liver and kidney function compared with the low SVV group. Conclusion: Goal-directed fluid therapy based on SVV guidance will facilitate intraoperative fluid input limitation and intraoperative fluid management in liver cancer surgery .

Key words: Goal-directed fluid therapy, Stroke volume variation, Liver cancer surgery, Liver and renal function

刘超, 邹亮, 郑晖. 不同每搏变异度指导下的目标导向液体治疗对肝癌手术患者术后肝肾功能的影响[J]. 肝癌电子杂志, 2020, 7(3): 12-16.

Liu Chao, Zou Liang, Zheng Hui. Effects of stroke volume variation guided goal-directed fluid therapy on liver and renal function of patients after liver cancer surgery[J]. Electronic Journal of Liver Tumor, 2020, 7(3): 12-16.

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