胸腔内血容积指数在老年食管癌根治术目标导向液体治疗中与应用.docVIP

中青年优秀论文评选 胸腔内血容积指数在老年食管癌根治术目标导向液体治疗中的应用 南方医科大学珠江医院麻醉科 (510282) 电话:020李凤仙 徐世元 刘中杰 刘辉 张庆国 许睿 【摘要】目的 观测老年病人单肺通气（OLV）行食管癌根治术中以胸腔内血容积指数（ITBVI）进行目标导向液体治疗对心指数（CI）、血管外肺水指数(EVLWI)、肺血管通透性(PVPI)的影响。方法 择期行食管癌根治术的老年患者16例，年龄65～82岁，ASAⅠ～Ⅱ级，胸腔内操作期间均行OLV。术中使用PiCCOTMplus系统进行各参数监测，容量治疗以维持合适的ITBVI为目标，观测麻醉前（T1）、全麻诱导后（T2）、侧卧位双肺通气20min（T3）、开胸后单肺通气20min（T4）、肺复张后双肺通气20min（T5）、平卧位双肺通气20min（T6）、拔除气管导管后（T7）各时点CI、EVLWI及PVPI的变化；观测OLV开始后15min、30min、45min、60min、75min、90min时连续心指数（PCCI）变化。记录OLV时间及尿量。结果 （1）ITBVI:与T1相比，T2时点明显降低；与T3相比，T6时点明显增加，其他时点无显著性差异。（2）CI:各时点数值均在正常范围内,与T1相比，T3时点明显下降；与T7相比，T3、T4及T5则显著下降，其它时点无显著性差异。（3）EVLWI: 各时点数值均高于正常参考值，但呈逐渐降低趋势。（4） Application of goal-directed fluid therapy with intrathoracic blood volume index during radical esophagectomy in the aged. LI Feng-xian，LIU Zhong-jie，XU Shi-yuan，et al. Department of Anesthesiology, Zhujiang hospital of South Medical university, Guangzhou, 510282, CHINA 【Abstract】 Objective To observe the cardiac index(CI) and the risk of pulmonary edema indicated by the extravascular lung water index(EVLWI) and pulmonary vascular permeability index(PVPI), while keeping the intrathoracic blood volume index(ITBVI) normal during radical esophagectomy in one lung ventilation(OLV) for thoracic percesure in the aged. Methods 16 patients, aged 65 to 82 years, ASA Ⅰ～Ⅱ,whom were received radical esophagectomy with OLV were observed. Thermodilution cather (PiCCOTMplus system) was taken into left femoral artery. Parameters such as CI,ITBVI, EVLWI and PVPI were monitored at seven time intervals：before(T1) and after anesthesia(T2)，total lung ventilation（TLV）20 minutes after lateral position(T3)，OLV 20 minutes after open the chest(T4), 20 minutes after pulmonary re-expansion（T5），20 minutes after supine position（T6）, just after extubation（T7）.Recorded OLV duration and urinary volume. Result ITBVI at T2 were significantly lower than those at T1，while at T3 were significantly lower than those at T6(P 0.05). CI was stable in all intervals. EVLWI