| 摘要: |
| ［摘要］ 目的 探讨目标导向液体治疗下控制性低中心静脉压（CLCVP）技术在脊柱手术中的应用效果。方法 选择2020年6月至2021年6月于暨南大学附属广州红十字会医院行脊柱手术（包括经后路椎管减压术、椎间盘摘除术、椎体间植骨椎弓根钉内固定术）的患者59例，采用随机数字表法将其分为L组（接受CLCVP液体治疗，20例）、G组（接受目标导向液体治疗，19例）和LG组（接受目标导向液体治疗下CLCVP，20例）。均采用静吸复合麻醉方法。比较三组入室时（T1）、诱导后（T2）、腰椎管减压前（T3）、椎管减压完成（T4）、手术结束（T5）的循环指标［包括平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）和心指数(CI)］和灌注指标［包括中心静脉-动脉二氧化碳分压差（Pcv-aCO2）、中心静脉血氧饱和度（ScvO2）和动脉血乳酸(Lac)］。比较三组手术时间、麻醉时长、液体输入量、液体丢失量。分析心指数均值(CIm)、平均动脉压均值（MAPm）和中心静脉压均值（CVPm）与术中出血量的相关性。结果 在T1～T5时间点，三组HR均呈上升趋势，CI变化波动不显著，三组变化幅度差异均无统计学意义（P>0.05）。在T2、T3时间点，G组MAP和CVP均显著高于L组和LG组，差异有统计学意义（P<0.05）。在T1～T5时间点，L组Pcv-aCO2呈逐渐上升趋势，而G组和LG组呈先上升后下降的趋势，变化差异有统计学意义（P<0.05）。在T1～T5时间点，三组Lac均呈逐渐上升的趋势，三组变化幅度差异有统计学意义（P<0.05）；在T4、T5时间点，L组Lac水平显著高于G组和LG组（P<0.05）。在T1～T5时间点，三组ScvO2均呈先上升后下降，变化差异无统计学意义（P>0.05）。G组晶体液、胶体液输入量以及液体总入量均显著大于L组和LG组（P<0.05），但L组和LG组比较差异无统计学意义（P>0.05）。G组术中失血量大于L组，尿量大于L组和LG组，差异有统计学意义（P<0.05）。结论 目标导向液体治疗下CLCVP技术有利于减少脊柱手术患者术中出血量，改善灌注情况。 |
| 关键词: 控制性低中心静脉压 目标导向液体治疗 脊柱手术 组织灌注 出血量 |
| DOI：10.3969/j.issn.1674-3806.2022.02.11 |
| 分类号:R 61 |
| 基金项目:广州市科技计划基金项目（编号：202103000022）；广东省医学科学技术研究基金项目（编号：A2021106） |
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| A study on the application effect of controlled low central venous pressure under goal-directed fluid therapy technique on spinal surgery |
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HUANG Hao-ran, CAO Yang, LIANG Bing
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Department of Anesthesiology, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangdong 510220, China
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| Abstract: |
| ［Abstract］ Objective To explore the application effect of controlled low central venous pressure(CLCVP) under goal-directed fluid therapy technique on spinal surgery. Methods Fifty-nine patients who underwent spinal surgery(including posterior spinal canal decompression, intervertebral disc removal, intervertebral bone grafting and pedicle screw internal fixation) in Guangzhou Red Cross Hospital Affiliated to Jinan University from June 2020 to June 2021 were selected. The patients were divided into L group(receiving CLCVP fluid therapy, 20 cases), G group(receiving goal-directed fluid therapy, 19 cases) and LG group(receiving CLCVP under goal-oriented fluid therapy, 20 cases) by the random number table method. All the groups received combined intravenous inhalational anesthesia. The circulatory indicators［including mean arterial pressure(MAP), heart rate(HR), central venous pressure(CVP) and cardiac index(CI)］ and perfusion indicators［including central venous-arterial carbon dioxide partial pressure difference(Pcv-aCO2), systemic central venous oxygen saturation(ScvO2) and arterial blood lactate(Lac)］ were compared among the three groups at the time of entry(T1), after induction(T2), before lumbar spinal canal decompression(T3), at the completion of spinal canal decompression(T4), and at the end of surgery(T5). The operation time, duration of anesthesia, fluid input and fluid loss were compared among the three groups. The correlation between mean of CI(CIm), mean of MAP(MAPm), mean of CVP(CVPm) and intraoperative blood loss was analyzed. Results From T1 to T5 time points, HR showed an upward trend in the three groups, and the fluctuation of CI was not significant, and the range of the changes was not statistically significant among the three groups(P>0.05). At the T2 and T3 time points, the MAP and the CVP in the G group were significantly higher than those in the L group and the LG group, and the differences were statistically significant(P<0.05). From T1 to T5 time points, Pcv-aCO2 showed a gradual upward trend in the L group, while a trend of rising first and then falling in the G group and the LG group, and the differences in the changes were statistically significant(P<0.05). From T1 to T5 time points, the Lac showed a gradual upward trend in the three groups, and the difference in the range of the changes was statistically significant among the three groups(P<0.05). At T4 and T5 time points, the Lac level in the L group was significantly higher than that in the G group and the LG group(P<0.05). From T1 to T5 time points, ScvO2 increased first and then decreased in the three groups, and there were no statistically significant differences in the changes(P>0.05). The input volume of crystal liquid, colloidal fluid, and total fluid input in the G group were significantly greater than those in the L group and the LG group(P<0.05), but there were no significant differences between the L group and the LG group(P>0.05). The intraoperative blood loss in the G group was greater than that in the L group, and the urine output in the G group was greater than that in the L group and the LG group, and the differences were statistically significant(P<0.05). Conclusion CLCVP under goal-directed fluid therapy technique is beneficial to reduce intraoperative blood loss and improve perfusion in patients undergoing spinal surgery. |
| Key words: Controlled low central venous pressure(CLCVP) Goal-directed fluid therapy Spinal surgery Tissue perfusion Blood loss |
