动态血流动力学指标在梗阻性黄疸患者围术期的应用-麻醉专业论文.docxVIP

有中等的预测液体反应能力以外，SVV 和 PVI 均不能准确的预测液体反应。 第二部分：应用 PPV 指导梗阻性黄疸患者围术期容量管理的研究 目的：分析 PPV 指导梗阻性黄疸患者围术期容量管理对预后的影响。方法： 60 例梗阻性黄疸患者随机分为 PPV 组(n=30)和对照组(n=30)，PPV 组通过 输注胶体维持 PPV 在 8%以下，对照组由麻醉医生根据临床经验确定容量管 理方案。比较两种容量管理方案对患者乳酸水平、术后 30 天并发症及死亡 率、术后住院日以及 ICU 住院日等的影响。结果：手术过程中 PPV 组输注 了更多的胶体(1245±350vs776±391ml，P＜0.001)，但两组液体总出入量以及 血管活性药物用量 无差别 。 手术结束时 PPV 组乳酸水平低于对照 组 (1.45±0.63vs 1.93±0.88 mmol/L，P=0.024)。实验组术后并发症发病率低于对 照组但未达到统计学差异(25.9%vs39.3%，P=0.291)。两组在死亡率、ICU 及术后住院日等方面没有差别。结论：应用 PPV 指导梗阻性黄疸患者围术 期容量管理有减少术后并发症的趋势。 关键词：动态血流动力学指标，梗阻性黄疸，液体反应，容量管理，围术期， 术后并发症。 2 Application of dynamic indices in patients with obstructive jaundice in the perioperative period Abstract Perioperative fluid administration is one of essential preventative strategies to control the postoperative complications and mortality in patients. The current, routinely used static indicators of cardiac preload have been shown to be poor predictors of fluid responsiveness. Previous studies have shown that the dynamic variables such as stroke volume variation (SVV), pulse pressure variation (PPV) or pleth variability index (PVI) could be successfully used for predicting fluid responsiveness in different patient populations, with the suggestion that these approaches could improve postoperative outcomes. However, the validation of SVV and PPV in patients with obstructive jaundice has not been studied so far. The aim of this study was to validate the ability of SVV, PPV and PVI to predict fluid responsiveness in patients with obstructive jaundice, and these dynamic indexes’ influence on postoperative morbidity and mortality. PartⅠAssessment of dynamic indices for predicting fluid responsiveness in patients with obstructive jaundice Objective: To validate the ability of SVV, PPV and PVI to predict fluid responsiveness in mechanically ventilated patients with obstructive jaundice.Methods: Thirty-five patients with obstructive jaundice received volume expansion with 250 mlcolloids immediately after induction of anesthesia or