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投稿时间：2025-02-19 网络发布日期：2025-10-20
投稿时间：2025-02-19 网络发布日期：2025-10-20
中文摘要: 目的 比较上腔静脉塌陷指数（SVC-CI）指导的目标导向液体治疗（GDFT）与中心静脉压（CVP）指导的GDFT对腹腔镜肝切除术中出血及术后早期恢复的影响。方法 纳入2023年3月至2024年3月江苏大学附属高淳医院行腹腔镜肝切除术患者70例，采用随机数字表法将患者分为两组：S组采用SVC-CI＞36％为目标指导术中液体治疗；C组采用CVP＜5 cmH2O为目标指导术中液体治疗。比较两种治疗方案对患者术中出血、液体出入量、血管活性药物使用量、动脉血气指标、肾功能、麻醉复苏室（PACU）驻留时间、下床时间、首次排气时间及住院时间的影响。结果 S 组和 C 组患者术中出血量差异无统计学意义［（366.65±24.69）mL vs（358.45±33.26）mL，t=1.072，P=0.288］，除术后24 h外，两组血肌酐、尿素氮水平差异均无统计学意义（P>0.05）。S组术中复方氯化钠输注量小于C组，羟乙基淀粉输注量和术中尿量大于C组（P<0.05）；S组切肝时和切肝后平均动脉压高于C组，心率低于C组（P<0.05）；术中去甲肾上腺素及硝酸甘油使用量低于C组［（164.46±34.54）μg vs（355.68±28.36）μg，t=23.276，P <0.01；（126.43±27.48）μg vs（412.38±16.40）μg，t=48.728，P <0.01］；手术结束时动脉乳酸水平低于C组［（0.97±0.13）mmol/L vs（1.28±0.12）mmol/L，P<0.05］，术后 PACU 驻留时间短于 C 组，首次排气时间早于C组，差异有统计学意义（P<0.05）。两组术后下床时间、住院时间差异均无统计学意义（P>0.05）。结论 在腹腔镜肝切除术中SVC-CI指导的GDFT可优化术中容量管理，改善组织灌注，缩短术后早期恢复时间，可为腹腔镜肝切除术提供更精准的液体治疗策略。
Abstract:Objective To compare the effects of superior vena cava collapsibility index（SVC-CI）guided goal-directed fluid therapy（GDFT）and central venous pressure（CVP）guided GDFT on bleeding and early postoperative recovery during laparoscopic hepatectomy. Methods Seventy patients who underwent laparoscopic hepatectomy in Gaochun Hospital Affiliated to Jiangsu University from March 2023 to March 2024 were included. The patients were randomly divided into two groups using a random number table method. Group S received intraoperative liquid therapy guided by SVC-CI>36% as the target，group C used CVP <5 cmH2O as the target to guide intraoperative liquid therapy. The effects of two treatment options on intraoperative blood loss，fluid input and output，use of vasoactive drugs，arterial blood gas indicators，renal function，post anesthesia care unit（PACU）stay，time to ambulation，time to first anal exhaust and hospital stay in patients. Results There was no significant difference in intraoperative blood loss between patients in group S and group C［（366.65 ± 24.69）mL vs（358.45 ± 33.26）mL，t=1.072，P=0.288］，except for 24 hours after surgery，no statistically significant difference was found in serum creatinine and urea nitrogen levels between the two groups（P>0.05）. Compared with group C ，the intraoperative amount of compound sodium chloride infusion in group S was lower，while the intraoperative amount of hydroxyethyl starch infusion and intraoperative urine volume were higher（P<0.05）；the mean arterial pressure at and after hepatectomy in group S were higher，and the heart rate was lower（P<0.05）；intraoperative dosage of norepinephrine and nitroglycerin were lower［（164.46 ±34.54）μg vs（355.68±28.36）μg，t=23.276，P <0.01；（126.43±27.48）μg vs（412.38±16.40）μg，t=48.728，P <0.01］；arterial lactate level at the end of the operation was lower［（0.97±0.13）mmol/L vs（1.28±0.12）mmol/L，P<0.05］，postoperative PACU stay was shorter，and time to ambulation was earlier；all with statistical significances（P<0.05）.There was no significant difference in postoperative time to ambulation and hospital stay between the two groups（P>0.05）. Conclusion In laparoscopic hepatectomy， SVC - CI guided GDFT optimizes intraoperative volume management，improves tissue perfusion，shortens early postoperative recovery time，and offers a more precise fluid therapy strategy for laparoscopic hepatectomy.
keywords: Laparoscopic hepatectomy Superior vena cava collapsibility index Central venous pressure Goal-directed fluid therapy Capacity management Tissue perfusion Postoperative recovery
文章编号： 中图分类号：R657.3 文献标志码：A
基金项目:江苏大学医教协同创新基金研究项目（JDYY2023027）
附件
| Author Name | Affiliation |
| YANG Chuanming*，WANG Yelong，JIANG Xueqing，XU Zhihua，SUN Jie，FENG Chaonan | *Department of Anesthesiology,Zhongda Hospital Southeast University,Nanjing,Jiangsu 210009,China |
引用文本：
杨传铭,王叶龙,江雪晴,等.上腔静脉塌陷指数指导与中心静脉压指导的目标导向液体治疗在腹腔镜肝切除术中的比较[J].中国临床研究,2025,38(10):1494-1499.
杨传铭,王叶龙,江雪晴,等.上腔静脉塌陷指数指导与中心静脉压指导的目标导向液体治疗在腹腔镜肝切除术中的比较[J].中国临床研究,2025,38(10):1494-1499.