加速康复外科模式下目标导向液体治疗在结核病患者胸膜剥脱手术中的疗效评价

doi:10.19871/j.cnki.xfcrbzz.2023.04.006

新发传染病电子杂志 ›› 2023, Vol. 8 ›› Issue (4): 25-29.doi: 10.19871/j.cnki.xfcrbzz.2023.04.006

加速康复外科模式下目标导向液体治疗在结核病患者胸膜剥脱手术中的疗效评价

钟祥鹏¹, 刘永¹, 刘强², 刘炜婷³, 刘民强¹, 何仁亮¹, 吴强¹

1.深圳市第三人民医院手术麻醉科,广东深圳 518112;
2.深圳市第三人民医院急诊科,广东深圳 518112;
3.深圳市第三人民医院神经外科,广东深圳 518112

收稿日期:2023-01-28 出版日期:2023-08-31 发布日期:2023-09-26
通讯作者: 吴强,Email：wq2283@qq.com
基金资助:
2021年深圳市第三人民医院院内项目（G2021001）

Evaluation of efficacy of goal directed fluid therapy in pleural exfoliation surgery of tuberculosis patients under enhanced recovery after surgery mode

Zhong Xiangpeng¹, Liu Yong¹, Liu Qian², Liu Weiting³, Liu Minqiang¹, He Renliang¹, WuQiang¹

1. Department of Anesthesiology,The Third People's Hospital of Shenzhen, Guangdong Shenzhen 518112, China;
2. Department of Emergency, The Third People's Hospital of Shenzhen, Guangdong Shenzhen 518112, China;
3. Department of Neurosurgery, The Third People's Hospital of Shenzhen, Guangdong Shenzhen 518112, China

Received:2023-01-28 Online:2023-08-31 Published:2023-09-26

摘要/Abstract

摘要： 目的探讨结核病患者胸膜剥脱手术中的加速康复外科模式下目标导向液体治疗对减轻患者术后肺水肿的治疗价值。方法选取2021年1月至2022年5月拟行胸膜剥脱手术的结核病患者60例作为研究对象,随机将60例患者分为试验组（S组）和对照组（C组）,每组各30例,S组采用目标导向液体治疗策略,根据每搏量变异（SVV）调整液体量,C组采用常规液体治疗方案,根据有创平均动脉压、中心静脉压及尿量等参数调整补液量,在术前、术后第1天、术后第3天采用肺水肿影像学评分（Rale评分）系统对患者胸部正位片进行评分,评估患者术后肺水肿发生情况,分别在麻醉诱导前5min（T1）、气管插管后5min（T2）、手术开始（T3）、手术1h（T4）、手术结束（T5）记录的平均动脉压（MAP）、心率（HR）、指尖脉氧饱和度（SPO₂）和气道峰压（PEAK）的变化,记录术后并发症发生的情况;分别于手术前ld、术后第1天和术后第3天对患者进行全身麻醉术后恢复质量评分（QoR-15),评估患者术后恢复情况。结果与C组相比,S组术后第1天Rale评分较低（P<0.05）,术后第3天两组患者Rale评分无明显差异;两组术中生命体征差异无统计学意义;S组输液量较C组少（P<0.01）;拔管时间、术后住院时间、尿量、QoR-15评分均无明显差异。结论目标导向液体治疗可以在结核病患者胸膜剥脱手术中减轻术后急性肺水肿严重程度,维持稳定的循环同时减少术中输液量。

关键词: 目标导向液体治疗, 容量管理, 结核性胸膜炎, 胸膜剥脱手术, 每搏量变异

Abstract: Objective To explore the therapeutic value of GDFT in reducing pulmonary edema after pleurodectomy in tuberculosis patients. Method From January 2021 to May 2022, 60 patients who plan to undergo pleural exfoliation surgery with tuberculosis were enrlled as the research subjects, and they were randomly divided into the group S and the group C equally. Group S accepted the goal-directed fluid therapy, and the transfusion speed was adjusted according to the Stroke volume variation(SVV). Group C accepted the traditional liquid treatment, which according to the mean arterial pressure(MAP), central venous pressure, urinary production and other parameters. Radiographic assessment of lung edema (rale scoring) was used to evaluate the patients' pulmonary disease before operation, on the first day after operation, and on the third day after operation. Mean arterial pressure (MAP), heart rate (HR),pulse oxygen saturation(SPO₂) and peak airway pressure (PEAK)were recorded at five moment（T1, 5minutes before anesthesia; T2, 5minutes after tracheal intubation; T3, Beginning of the surgery; T4, Surgery was started for 1 hour; T5, the end of surgery）, the occurrence of postoperative complications also were recorded; The postoperative recovery quality score (The QoR-15) was performed on patients 1 day before surgery, the first postoperative day, and the third postoperative day to evaluate their postoperative recovery. Result Compared with group C, the rale score in group S was lower on the first postoperative day (P<0.05), and there was no significant difference in rale scores between the two groups on the third postoperative day; There was no statistically significant difference in intraoperative vital signs between the two groups; The infusion volume in group S was lower than group C (P<0.01); There was no significant difference in extubation time, postoperative hospital stay, urinary production and QoR-15 score. Conclusion GDFT can mitigate postoperative acute pulmonary edema and maintain stable circulation while reducing the infusion volume in TB patients.

Key words: Goal directed fluid therapy, Capacity management, Tuberculous pleurisy, Pleural exfoliation surgery, Stroke volume variation

中图分类号:

R614
R52

钟祥鹏, 刘永, 刘强, 刘炜婷, 刘民强, 何仁亮, 吴强. 加速康复外科模式下目标导向液体治疗在结核病患者胸膜剥脱手术中的疗效评价[J]. 新发传染病电子杂志, 2023, 8(4): 25-29.

Zhong Xiangpeng, Liu Yong, Liu Qian, Liu Weiting, Liu Minqiang, He Renliang, WuQiang. Evaluation of efficacy of goal directed fluid therapy in pleural exfoliation surgery of tuberculosis patients under enhanced recovery after surgery mode[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(4): 25-29.

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加速康复外科模式下目标导向液体治疗在结核病患者胸膜剥脱手术中的疗效评价

Evaluation of efficacy of goal directed fluid therapy in pleural exfoliation surgery of tuberculosis patients under enhanced recovery after surgery mode

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