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中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (07) : 497 -502. doi: 10.3877/cma.j.issn.1674-0785.2021.07.004

临床研究

Lac、ScvO2与Pcv-aCO2对老年患者全腔镜食管癌根治术时液体管理的指导作用
赵继波1, 张立立2, 李媛莉3, 孙晓佳1, 张媛4, 夏登云1, 李福龙1, 滕金亮1, 邢珍1,()   
  1. 1. 075000 河北张家口,河北北方学院附属第一医院麻醉科
    2. 075000 河北张家口,河北北方学院附属第一医院危重症医学科
    3. 075000 河北张家口,河北北方学院附属第一医院手术室
    4. 054000 河北邢台,河北省眼科医院手麻科
  • 收稿日期:2021-05-24 出版日期:2021-07-15
  • 通信作者: 邢珍
  • 基金资助:
    2021年度河北省医学科学研究课题计划(20210754)

Role of lactic acid, ScvO2, and Pcv-aCO2 in guiding liquid management of elderly patients during totally endoscopic radical resection of esophageal cancer

Jibo Zhao1, Lili Zhang2, Yuanli Li3, Xiaojia Sun1, Yuan Zhang4, Dengyun Xia1, Fulong Li1, Jinliang Teng1, Zhen Xing1,()   

  1. 1. Department of Anesthesiology, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
    2. Department of Hand Anesthesia, Hebei Eye Hospital, Xingtai 054000, China
    3. Department of Critical Care Medicine, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
    4. Operating Room, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
  • Received:2021-05-24 Published:2021-07-15
  • Corresponding author: Zhen Xing
引用本文:

赵继波, 张立立, 李媛莉, 孙晓佳, 张媛, 夏登云, 李福龙, 滕金亮, 邢珍. Lac、ScvO2与Pcv-aCO2对老年患者全腔镜食管癌根治术时液体管理的指导作用[J/OL]. 中华临床医师杂志(电子版), 2021, 15(07): 497-502.

Jibo Zhao, Lili Zhang, Yuanli Li, Xiaojia Sun, Yuan Zhang, Dengyun Xia, Fulong Li, Jinliang Teng, Zhen Xing. Role of lactic acid, ScvO2, and Pcv-aCO2 in guiding liquid management of elderly patients during totally endoscopic radical resection of esophageal cancer[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(07): 497-502.

目的

探讨乳酸(Lac)、中心静脉血氧饱和度(ScvO2)、中心静脉-动脉血二氧化碳分压差(Pcv-aCO2)联合常规检测指标指导老年患者全腔镜食管癌根治术单肺通气时液体管理的作用。

方法

收集2020年6月至2021年4月河北北方学院附属第一医院择期全麻下行全腔镜食管癌根治术的老年患者41例,随机分为观察组(21例)和对照组(20例),均给予全身麻醉。2组患者麻醉诱导期快速静脉输注乳酸林格液250 ml,随后以4~8 ml/(kg·h)的速率持续静脉输注。对照组根据平均动脉压(MAP)和中心静脉压(CVP);观察组根据ScvO2、Pcv-aCO2和Lac调整输液量及血管活性药物使用情况。收集各组患者麻醉诱导前5 min(T0)、气管插管后5 min(T1)、单肺通气前(T2)、单肺通气1 h(T3)、单肺通气结束(T4)各时间点的心率(HR)、MAP、CVP、尿量、输液量、出血量、Lac、ScvO2、Pcv-aCO2等指标,并进行组间、组内的比较。

结果

2组患者性别、年龄比较,差异无统计学意义(P>0.05)。组内比较发现,2组MAP、HR在T1~T4时间点均低于T0P<0.05),T1~T4各时间点间比较均无统计学差异(P>0.05);观察组CVP各时间点差异无统计学意义(P>0.05),对照组CVP在T3、T4时间点较T0~T2明显升高,且T3、T4时间点间差异有统计学意义(P<0.05);2组各时间SPO2差异均无统计学意义(P>0.05)。组间比较显示,2组T0、T1时间点MAP无统计学差异(P>0.05),观察组T2~T4时间点MAP明显高于对照组(P<0.05);2组T0~T2时间点CVP无统计学差异(P>0.05),观察组T3、T4时间点CVP明显低于对照组(P<0.05);2组患者术中出血量、SPO2、HR无统计学差异(P>0.05);观察组尿量明显高于对照组(P<0.05),总输液量、血管活性药物剂量低于对照组(P<0.05)。观察组中T0~T2时间点Lac、ScvO2无明显差异,T3、T4时间点Lac明显升高,ScvO2明显降低(P<0.05);T0~T3时间点Pcv-aCO2无明显变化,T4时间点Pcv-aCO2明显升高(P<0.05)。

结论

Lac、ScvO2和Pcv-aCO2与老年患者全腔镜食管癌根治术单肺通气具有相关性,单肺通气时间越久,Lac和Pcv-aCO2升高越明显,ScvO2下降越明显。

Objective

To explore the use of lactic acid (Lac), central venous oxygen saturation (ScvO2), and central venous-arterial carbon dioxide partial pressure (Pcv-aCO2) combined with routine indicators in guiding the fluid management of elderly patients with single-lung ventilation during totally endoscopic radical resection of esophageal cancer.

Methods

Forty-one elderly patients with esophageal cancer who underwent laparoscopic radical resection under elective general anesthesia at First Affiliated Hospital of Hebei North University from June 2020 to April 2021 were included. The study subjects were randomly divided into an observation group (21 cases) and a control group (20 cases). Patients of the two groups were given a rapid intravenous infusion of 250 ml of lactated Ringer's solution during the anesthesia induction period, followed by continuous intravenous infusion at a rate of 4-8 ml/(kg·h). The control group was based on mean arterial pressure (MAP) and central venous pressure (CVP), and the observation group was based on ScvO2, Pcv-aCO2 and Lac to adjust the infusion volume and the use of vasoactive drugs. The heart rate (HR), MAP, CVP, urine volume, infusion volume, bleeding volume, Lac, ScvO2, Pcv-aCO2, and other indicators were recorded and compared between groups at 5 min before induction of anesthesia (T0), 5 min after tracheal intubation (T1), before one-lung ventilation (T2), 1 h of one-lung ventilation (T3), and the end of one-lung ventilation (T4).

Results

There were no statistically significant differences in gender or age between the two groups (P>0.05). MAP and HR at T1-T4 were significantly lower than those at T0 in both groups (P<0.05), but there were no statistically significant differences among T1-T4 (P>0.05). There were no significant difference in CVP among all time points in the observation group (P>0.05); in the control group, CVP at T3 and T4 were significantly higher than those at T0-T2, and the difference between T3 and T4 was also statistically significant (P<0.05). There were no significant difference in SPO2 at each time point between the two groups (P>0.05). There was no significant difference between the two groups in MAP at T0 and T1 (P>0.05); MAP at T2, T3, and T4 were significantly higher in the observation group than in the control group (P<0.05). There was no difference between the two groups in CVP at T0-T2 (P>0.05); CVP at T3 and T4 were significantly lower in the observation group than in the control group (P<0.05). There were no significant differences in intraoperative blood loss, SPO2, or HR between the two groups (P>0.05). In the observation group, the urine output was significantly higher, and the total infusion volume and the dose of vasoactive drugs were lower than those of the control group (P<0.05). In the observation group, there was no significant difference in Lac or ScvO2 at T0-T2, while at T3 and T4, Lac were significantly increased (P<0.05) and ScvO2 was significantly decreased (P<0.05). Pcv-aCO2 had no statistically significant difference at T0-T3, but it significantly increased at T4 (P<0.05).

Conclusion

Lac, ScvO2, and Pcv-aCO2 are correlated with single-lung ventilation in elderly patients with totally endoscopic radical resection of esophageal cancer. The longer the single-lung ventilation time, the more obvious increase of Lac and Pcv-aCO2 and decrease of ScvO2.

表1 2组行腔镜食管癌根治术的老年患者一般情况及麻醉监测指标比较
项目 观察组(21例) 对照组(20例) 统计值 P
性别(例,男/女) 14/7 11/9 χ2=2.61 0.45
年龄(岁,
x¯
±s
75.9±6.55 75.5±6.17 t=0.20 0.84
MAP(mmHg,
x¯
±s

T0

95.43±5.39 93.45±4.94 t=1.22 0.22

T1

81.14±6.49a 78.35±6.02a t=1.43 0.16

T2

81.33±6.18a 77.25±5.49a t=2.23 0.03

T3

83.67±8.99a 77.80±7.30a t=2.28 0.02

T4

85.43±5.09a 78.15±6.67a t=3.94 <0.01
HR(次/min,
x¯
±s

T0

95.43±5.39 93.45±4.94 t=-0.21 0.83

T1

81.14±6.49a 78.35±6.02a t=-1.14 0.26

T2

81.33±6.18a 77.25±5.49a t=0.19 0.84

T3

83.67±8.99a 77.80±7.03a t=0.68 0.49

T4

85.43±5.08a 78.15±6.67a t=-0.08 0.93
CVP(cmH2O,
x¯
±s

T0

9.02±2.07 9.11±2.26 t=0.11 0.93

T1

8.99±2.19 9.04±2.02 t=0.86 0.21

T2

8.78±2.81 8.89±2.81 t=1.44 0.78

T3

8.57±3.02 10.92±2.98abc t=2.99 0.01

T4

9.01±3.31 10.04±3.29abcd t=0.41 <0.01
SPO2(%,
x¯
±s

T0

98.95±1.57 98.81±1.56 t=3.65 0.16

T1

98.56±1.78 97.89±1.67 t=-0.28 0.78

T2

98.01±1.45 98.72±1.99 t=-0.19 0.34

T3

97.99±2.32 97.67±2.43 t=0.06 0.18

T4

98.24±1.79 98.15±1.84 t=-0.32 0.89
出血量(ml,
x¯
±s
161.90±31.56 164.00±33.89 t=-0.21 0.84
尿量(ml,
x¯
±s
846.50±115.49 740.48±166.09 t=-2.36 0.02
总输液量(ml,
x¯
±s)(晶体∶胶体=1∶1)
3061.90±625.68 3801.00±581.85 t=-3.91 <0.01

晶体液

1877.14±430.32 2390.00±456.42 t=-3.70 <0.01

胶体液

1184.76±341.58 1411.00±288.19 t=-2.96 <0.01
血管活性药物(μg,
x¯
±s
260.67±36.53 456.05±29.95 t=-18.67 <0.01
表2 观察组患者不同时间点Lac、ScvO2、Pcv-aCO2比较(
xˉ
±s
表3 观察组患者非单肺通气与单肺通气时间点Lac、ScvO2、Pcv-aCO2比较(
xˉ
±s
1
李凤仙, 刘中杰, 徐世元, 等. 胸腔内血容积指数在老年食管癌根治术目标导向液体治疗中的应用 [J]. 临床麻醉学杂志, 2012, 28(1): 11-13.
2
郭小琦, 薛锋, 王鹏国, 等. 目标导向液体治疗对老年食管癌根治术患者围手术期血流动力学、血乳酸及细胞免疫功能的影响 [J]. 癌症进展, 2017, 15(10): 1209-1212.
3
徐悦利, 刘娜, 李汝泓, 等. 目标导向液体治疗联合肺复张在食管癌根治术患者的应用观察 [J]. 河北医学, 2016, 22(11): 1786-1789.
4
Dubin A, Pozo MO, Kanoore Edul VS, et al. Poor agreement in the calculation of venoarterial PCO2 to arteriovenous O2 content difference ratio using central and mixed venous blood samples in septic patients [J]. J Crit Care, 2018, 48: 445-450.
5
Mesquida J, Saludes P, Gruartmoner G, et al. Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock [J]. J Crit Care, 2015, 19: 126-132.
6
沈明勇. 血乳酸联合中心静脉血氧饱和度指导脓毒症休克患者的容量管理 [J]. 中国临床医生杂志, 2017, 45(11): 44-47.
7
Zampieri FG, Damiani LP, Bakker J, et al. Effects of a resuscitation strategy targeting peripheral perfusion status versus serum lactate levels among patients with septic shock. A bayesian reanalysis of the ANDROMEDA-SHOCK trial [J]. Am J Respir Crit Care Med, 2020, 201(4): 423-429.
8
Stacpoole PW, Wright EC, Baumgartner TG, et al. A controlled clinical trial of dichloroacetate for treatment of lactic acidosis in adults [J]. NEJM, 1992, 327(22): 1564.
9
王雪婷, 高雪花, 曹雯, 等. 血乳酸联合中心静脉-动脉血二氧化碳分压差与动脉-中心静脉血氧含量差比值预测脓毒症休克患者预后的应用价值 [J]. 中华危重病急救医学, 2020, 32(1): 39-43.
10
仲艾芳, 温建立, 林宇斌, 等. 乳酸、P(v-a)CO2及P(v-a)CO2/C(a-v)O2在脓毒性休克早期液体复苏中的研究进展 [J]. 系统医学, 2018, 3(1): 191-193.
11
刘亚林, 张雪飞, 赵中林, 等. P(cv-a)CO2评价创伤性休克患者液体复苏效果的价值 [J].海南医学, 2015, 26(10): 1441-1443.
12
罗文恒. 中心静脉-动脉血二氧化碳分压差在感染性休克液体复苏中的应用 [J]. 中国医药指南, 2014, 12(19): 259-259.
13
张玉奇, 李小悦. 中心静脉-动脉二氧化碳分压差在休克评估中的研究进展 [J/CD]. 中华卫生应急电子杂志, 2020, 6(2): 112-114.
14
王鸿, 侯洪. P(cv-a)CO2与乳酸对休克液体复苏指导作用的研究 [J]. 中国继续医学教育, 2020, 12(9): 105-107.
15
朱建宏, 邓佳慧, 郑咏仪,等. 静-动脉二氧化碳分压差联合中心静脉血氧饱和度对脓毒症患者灌注情况评估的意义 [J]. 岭南急诊医学杂志, 2020, 25 (4): 326-328.
16
Chamberlain DJ, Willis EM, Bersten AB. The severe sepsis bundles as processes of care: A meta-analysis [J]. Aust Crit Care, 2011, 24(4): 229-243.
17
Gavelli F, Teboul JL, Monnet X. How can CO2-derived indices guide resuscitation in critically ill patients? [J]. J Thorac Dis, 2019, 11(S11): S1528-S1537.
18
牛杏果, 张思森, 焦宪法, 等. ScvO2联合P(cv-α)CO2监测在感染性休克患者液体复苏中的指导意义及对预后的影响 [J]. 中国急救医学, 2019, 39(10): 939-944.
19
尚宝朋, 李彦德, 麦志伟, 等. ScvO2联合P(cv-a)CO2在感染性休克患者液体复苏中的临床应用 [J]. 黑龙江医学, 2019, 43(5): 493-495.
20
莫旻龙, 李恒, 李小悦. Pcv-aCO2对失血性休克患者液体复苏后氧合障碍的预测价值[J]. 岭南急诊医学杂志, 2017, 22(3): 205-207.
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