术中目标导向液体治疗对腹腔镜胃袖状切除术患者术后康复的影响

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摘要目的：探讨对行腹腔镜胃袖状切除术的肥胖患者，术中目标导向液体治疗（goaldirected fluid therapy, GDFT）术后康复效果是否优于限制性液体治疗（restrictive fluid therapy, RFT）。方法：选取2021年5月至10月徐州医科大学附属医院择期行全麻腹腔镜胃袖状切除术的肥胖患者60例，按照随机数字表法分为RFT组和GDFT组，每组各30例。RFT组维持心率及平均动脉压波动幅度不超过术前基线水平的20%。GDFT组采用唯捷流监测系统监测每搏变异度（stroke volume variation, SVV），维持SVV≤13%。观察两组术后并发症的发生情况；比较两组术中血管活性药的使用及术中低血压的发生情况，术后首次排气时间，胃肠道生活质量指数（gastrointestinal quality of life index，GIQLI）量表术前及术后2、5、10、16周的得分情况。结果：与RFT组比较，GDFT组术后并发症发生率明显降低（P＜0.05），术中血管活性药物使用率及术中低血压发生率明显降低（P均＜0.05），术后首次排气时间明显提前（P＜0.01）。术后2、5、10周GDFT组GIQLI评分明显高于RFT组（P均＜0.01）。结论：术中基于唯捷流监测系统的GDFT可促进肥胖患者术后康复，具有一定的临床价值。

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关键词 ：目标导向液体治疗, 限制性液体治疗, 胃袖状切除术, 肥胖患者, 术后康复, 加速康复外科, 围术期液体管理

Abstract：Objective： To compare the postoperative rehabilitation effect of the goaldirected fluid therapy （GDFT) and the restrictive fluid therapy （RFT) for obese patients undergoing laparoscopic sleeve gastrectomy. Methods： Sixty obese patients who underwent elective laparoscopic sleeve gastrectomy under general anesthesia from May to October 2021 in the Affiliated Hospital of Xuzhou Medical University were selected and divided into RFT group （group RFT) or GDFT （group GDFT) according to the random number table method, with 30 patients in each group. The fluctuation of heart rate and mean arterial pressure in group RFT did not exceed the preoperative baseline 20%. Group GDFT used the FloTrac/Vigileo monitoring system to monitor stroke volume variation （SVV), maintaining SVV≤13%. The incidence of postoperative complications in the two groups was observed. Between the two groups, the use of intraoperative vasoactive drugs and the incidence of intraoperative hypotension were compared; the first postoperative anal exhaust time was compared. The scores of gastrointestinal quality of life index （GIQLI) before and after surgery at 2, 5, 10, 16 weeks were compared. Results： Compared with group RFT, the incidence of postoperative complications in group GDFT was significantly reduced （P＜0.05）, the utilization of intraoperative vasoactive drugs and the incidence of intraoperative hypotension were also significantly lower （both P＜0.05), the first postoperative anal exhaust time was significantly earlier （P＜0.01). The GIQLI score in group GDFT was significantly higher than that in group RFT at 2, 5 and 10 weeks after surgery （all P＜0.05). Conclusion： The goaldirected fluid therapy based on the FloTrac/Vigileo can promote postoperative rehabilitation of obesity patients.

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收稿日期: 2022-03-25

基金资助:江苏省卫健委医学重点项目（ZD2021015）

通讯作者: 高芳（通讯作者）, 主任医师，硕士生导师，E-mail: 1458089673@qq.com

作者简介: 汪敏（1995—），女，硕士研究生

引用本文:

汪敏，杨奕，张克尧，等.. 术中目标导向液体治疗对腹腔镜胃袖状切除术患者术后康复的影响[J]. 江苏大学学报:医学版, 2022, 32(05): 439-443,451. WANG Min, YANG Yi, ZHANG Keyao, ZHAI Wenshan, GAO Fang. Effects of intraoperative goaldirected fluid therapy on postoperative rehabilitation of patients undergoing laparoscopic sleeve gastrectomy#br#. Journal of Jiangsu University(Medicine Edition), 2022, 32(05): 439-443,451.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2022/V32/I05/439

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