ITBVIEVLWI在老年重大胸部外伤手术中液体复苏应用研究.docVIP

ITBVIEVLWI在老年重大胸部外伤手术中液体复苏应用研究 　　【摘要】 目的：观察以胸腔内血容量指数（intrathoracic blood volume index，ITBVI）/血管外肺水指数（extravascular lung water index，EVLWI）在老年重大胸部外伤手术中液体复苏的应用研究。方法：急诊行重大胸部外伤手术的老年患者48例，随机分为以ITBVI/EVLWI为导向的研究组（Study group S组）和对照组（Routine group，R组），每组各24例患者。对照组监测CVP指导补液，研究组应用PICCO监测血流动力学指标，测定ITBVI、EVLWI等指标，准确评估患者容量状况。比较术中患者心率（HR）、平均动脉压（MAP）、中心静脉血氧饱和度（ScvO2）、乳酸等指标。观察术后休克改善情况及氧合指数，术后呼吸机通气时间，以及急性肺水肿发生率、死亡率变化。结果：研究组患者组织灌注改善，休克改善明显好转，氧合指数明显增加，中心静脉血氧饱和度明显增加，血乳酸浓度明显降低，急性肺水肿、死亡率明显低于对照组，两组比较差异均有统计学意义（P0.05）。结论：对比CVP，以ITBVI、EVLWI指导液体复苏，能更精确评估和指导老年重大胸部外伤手术患者术中液体管理，减少急性肺水肿发生率，减少呼吸机辅助时间，缩短ICU住院时间，降低死亡率。 　　【关键词】 ITBVI、EVLWI； 老年； 重大胸部外伤手术； 液体复苏 　　【Abstract】 Objective：To research the valve of ITBVI and EVLWI in fluid resuscitation of geriatric patients undergoing major chest trauma operation.Method：48 cases undergoing major chest trauma operation were included and randomly divided into two groups，24 cases in each group.The study group received pulse indicator continous output（PICCO） monitoring and ITBVI+EVLWI were used as indicator for fluid management.The control group was used central venous pressure （CVP） as indicator for fluid management.Heart rate （HR），mean arterial pressure （MAP），central venous oxygen saturation （ScvO2） and lactic acid were compared.Postoperative shock improvement and oxygenation index，duration of mechanical ventilation，the incidence of acute pulmonary edema as well as mortality in these two groups were observed and compared.Result：The study group of tissue perfusion and shock were significantly improved than that of control group and oxygenation index increased，ScvO2 of the study group was higher than that of the control group，the concentration of lactic acid of the study group was lower than that of the control group，the incidency rate of acute pulmonary edema and mortality rate of the study group were lower than that of the control group，the differences were statistically significant （P0.05）.Conclusion：Compared with CVP，ITBVI and EVLWI data can assess more