Flotracvigileo监测下的输液策略对妇科腹腔镜手术患者.docxVIP

Mz201812128临研（蒋） Mz201812128临研（蒋） 基金项目：内蒙古自治区人民医院院内基金（2016034） 作者单位：010017　呼和浩特市，内蒙古自治区人民医院麻醉科（王爱桃、包娜日素、铁木尔）； 华中科技大学附属武汉协和医院麻醉科（姚尚龙）；内蒙古医科大学研究生院（武娜、郭冬梅） 通信作者：王爱桃，Email：tjxhmzk@163.com Flotrac/vigileo监测下的输液策略对妇科腹腔镜手术患者 脑循环的保护作用 王爱桃　姚尚龙 包娜日素　武娜　郭冬梅 铁木尔 【摘要】：目的 探讨Flotrac/vigileo监测下的输液策略对脑血流动力学和颅内压（ICP）的影响。方法 选择择期妇科腹腔镜子宫切除术患者60例，年龄36~59岁，体重55~75kg，ASAⅠ或Ⅱ级，随机分为vigileo组（Ａ组）和对照组（Ｃ组），每组30例。两组患者均采用常规麻醉诱导气管插管全麻。A组根据vigileo的结果给予液体输注，C组根据421法则进行液体输注。记录两组患者麻醉诱导前（T0）、 气腹后10min（T1）、 30min（T2）、和60min（T3）时经颅多普勒超声仪测定患者大脑中动脉搏动指数（PI）和阻力指数（RI），脑水肿测定仪检测扰动系数的变化。结果 与T0时比较，T3时两组PI和RI明显增加，T1—T3时两组扰动系数明显增加（P＜0.05）；与C组比较，T3 时A组PI和RI明显降低，T2、T3时A组扰动系数明显降低（P＜0.05）。结论 术中利用vigileo精细化液体管理，可以降低妇科腹腔镜手术患者的脑水肿程度，缓解颅内压增高，更有利于维持相对稳定的脑循环。 【关键词】：唯截流；气腹；脑血流；颅内压 ?The protective effect of Flotrac/vigileo monitoring infusion strategies on cerebral circulation in patients undergoing gynecological laparoscopic surgery WANG Aitao, YAO Shanglong, BAO Narisu, WU Na, GUO Dongmei, TIE Muer, Department of Anesthesiology, Inner Mongolia Autonomous Region Peoples Hospital, Hohhot 010017, China Corresponding Auther：WANG Aitao, Email：tjxhmzk@163.com [Abstract] Objective To explore the effects of Flotrac/vigileo monitoring infusion strategies on cerebral hemodynamics and intracranial pressure (ICP). Methods Sixty patients with gynecological laparoscopic hysterectomy, aged 36-59, weight 55 - 75 kg, falling into ASA physical status I or II, were randomly divided into vigileo group (group A) and control group (group C), 30 cases in each group. Patients in both groups were given endotracheal intubation under general anesthesia. Group A was given liquid infusion according to the results of vigileo, while the group C was given liquid infusion according to rule 421. Middle cerebral artery pulse index and resistance index was measured by the transcranial doppler ultrasonography before anesthesia induction (T0), 10min (T1), 30min (T2), and 60min (T3) after pneumoperitoneum. Cerebral edema was determined by noninvasive brain edema