摘要
目的观察心排监测目标靶向液体治疗在经皮肾镜手术中的效果。方法选择昆明医科大学第二附属医院择期行经皮肾镜取石术ASAⅠ-Ⅱ级的患者60例,随机分为两组,A组使用CVP及ABP指导输液30例,B组监测心排指导输液30例。分别记录A、B两组患者诱导后3 min(T1)、俯卧位后3 min(T2)、冲水30 min(T3)、冲水60 min(T4)时的心率(HR)、平均动脉压(MAP),术前和术后的血乳酸值(lac)以及总输液量。结果与A组比较,B组在T2、T3、T4各时点MAP数值明显升高,差异具有统计学意义(P<0.05);B组的输液量比A组明显增多,差异具有统计学意义(P<0.05);与A组相比,B组术后乳酸值下降,差异具有统计学意义(P<0.05)。患者俯卧位后各时间点HR均未发生显著改变(P>0.05)。A、B两组患者俯卧位后各时点MAP数值均下降,与俯卧位前相比,差异有统计学意义(P<0.05),冲水30 min、60 min时患者血压较俯卧位后有所上升,但与俯卧位前比较仍低,差异有统计学意义(P<0.05)。结论俯卧位冲水对全身的循环灌注会产生显著影响,监测心排能更好指导输液,从而改善组织灌注。
Objective To observe the effect of cardiac monitoring targeted liquid therapy in percutaneous nephrolithotomy.Methods Sixty patients with ASAⅠ-Ⅱundergoing percutaneous nephrolithotomy were selected from the Second Affiliated Hospital of Kunming Medical University and were randomly divided into two groups.Group A used CVP and ABP to guide 30 cases of infusion,and group B used cardiac monitoring to guide 30 cases of infusion.The heart rate(HR)and mean arterial pressure(MAP)were recorded for the patients in group A and B after being induced for 3 min(T1),prone position for 3 min(T2),flushing for 30 min(T3),and flushing for 60 min(T4).The blood lactic acid value(Lac)and total infusion before and after surgery were recorded as well.Results Compared with group A,the MAP values of group B were significantly increased at T2,T3,and T4(P<0.05).The amount of infusion in group B was significantly higher than that in group A(P<0.05).Compared with group A,the lactic acid value of group B significantly decreased(P<0.05).There was no significant change in HR at each time point after prone position(P>0.05).The MAP values of the patients in both group A and group B decreased after the prone position,and the difference was significant compared with those before prone position(P<0.05).The blood pressure of the patients after flushing for 30 min and 60 min was higher than that after the prone position.However,they were still significantly lower than those before the prone position(P<0.05).Conclusion Prone position and flushing have a significant influence on circulated perfusion of the whole body,and cardiac monitoring can better guide infusion and improve tissue perfusion.
作者
周臣
张宁平
思永玉
李若鑫
陈建春
张宁丽
ZHOU Chen;ZHANG Ning-ping;SI Yong-yu;LI Ruo-xin;CHEN Jian-chun;ZHANG Ning-li(Dept.of Anesthesiology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101;Kunming Sanatorium,People’s Liberation Army,Kunming Yunnan 650307;Dept.of Anesthesiology,Yunnan Provincial Hospital of Integrated Traditional Chinese and Western Medicine,Kunming Yunnan 650224,China)
出处
《昆明医科大学学报》
CAS
2020年第3期41-44,共4页
Journal of Kunming Medical University
基金
国家自然科学基金资助项目(81060033)
云南省卫生系统学科带头人基金资助项目(D-201213)。
关键词
经皮肾镜取石术
心排监测
液体治疗
Percutaneous nephrolithotomy
Cardiac monitoring
Liquid therapy
作者简介
周臣(1985-),男,云南宣威人,医学硕士,主治医师,主要从事临床麻醉工作;通信作者:张宁丽,E-mail:394991505@qq.com。
