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目的探讨结直肠癌老年患者麻醉诱导前容量治疗下,下腔静脉(IVC)管径和下腔静脉呼吸衰减指数(IVC-CI)的变化及其与中心静脉压(CVP)的关系,为快速无创麻醉前容量判断和液体治疗提供理论依据。方法选择30例拟行结直肠癌切除术的患者(结直肠癌组),入手术室后记录心率(HR)、脉搏血氧饱和度(Sp O2)、平均动脉压(MAP),超声下测量IVC管径的最大值(IVCe)和最小值(IVCi),计算IVC-CI,局麻下行中心静脉穿刺测量CVP。然后在30 min内输入4%琥珀酰明胶注射液8 ml/kg,分别在液体治疗达4 ml/kg和8 ml/kg时再次测量并记录HR、Sp O2、MAP、IVC管径和IVC-CI及CVP的数值。另选择30例正常健康体检的成人(健康体检组)做基础值对照,测量HR、MAP、IVCe、IVCi和计算IVC-CI。结果结直肠癌组液体治疗前测得基础HR[(90.3±8.6)次/min]明显高于健康体检组[(75.8±9.8)次/min],结直肠癌组液体治疗前MAP[(65.6±7.3)mm Hg]、IVCe[(1.25±0.12)cm]、IVCi[(0.73±0.21)cm],明显低于健康体检组[MAP(85.7±8.9)mm Hg,IVCe(2.05±0.18)cm,IVCi(1.62±0.23)cm],结直肠癌组液体治疗前IVC-CI[(39±8)%]明显高于健康体检组IVC-CI[(16±13)%],差异均有统计学意义(P<0.01)。给予4%琥珀酰明胶注射液4ml/kg液体治疗后,HR逐渐下降到(82.4±6.5)次/min,MAP增加到(74.5±7.2)mm Hg,IVCe增至(1.56±0.21)cm,IVCi增至(1.12±0.34)cm,而IVC-CI明显降低至(29±7)%,CVP由(3.5±1.1)mm Hg上升至(5.3±2.1)mm Hg,与治疗前相比差异均有统计学意义(P<0.05);给予4%琥珀酰明胶注射液8 ml/kg液体治疗后,HR下降至(77.2±5.8)次/min,MAP增高至(83.7±8.6)mm Hg,IVCe增加至(1.88±0.22)cm,IVCi增加至(1.52±0.27)cm,而IVC-CI降低至(21±5)%,CVP增加至(7.4±2.3)mm Hg,与治疗前相比差异均有统计学意义(P<0.01)。同时,液体治疗前和液体治疗后,IVCe和IVCi均与CVP呈正相关(治疗前r=0.782,r=0.721,P=0.000;治疗后r=0.825,r=0.796,P=0.000);IVC-CI与CVP呈负相关(治疗前r=-0.732,治疗后r=-0.774,P=0.000)。结论 IVC管径和IVC-CI能够指导结直肠癌老年患者麻醉诱导前容量治疗。
Objective To investigate the changes of IVC-IVC and IVC-CI and its relationship with central venous pressure (CVP) before anesthesia induction in elderly patients with colorectal cancer. Noninvasive anesthesia to determine the capacity and liquid therapy to provide a theoretical basis. Methods Thirty patients undergoing colorectal cancer resection (colorectal cancer group) were enrolled in the study. Heart rate (HR), Sp O2 and mean arterial pressure (MAP) IVC maximum diameter (IVCe) and minimum (IVCi), calculated IVC-CI, local anesthetic central venous catheterization measured CVP. Then 4% succinyl gelatin injection 8 ml / kg was administered within 30 min, HR, Sp O2, MAP, IVC caliber and IVC-I were again measured and recorded at 4 ml / kg and 8 ml / CI and CVP values. Another 30 normal healthy people (healthy group) were selected as the baseline value, HR, MAP, IVCe, IVCi and IVC-CI were calculated. Results The baseline HR [(90.3 ± 8.6) times / min) in the colorectal cancer group was significantly higher than that in the healthy group [(75.8 ± 9.8) times / min) IVCe [(0.73 ± 0.21) cm] was significantly lower than that of the healthy control group [MAP (85.7 ± 8.9) mm Hg, IVCe (2.05 ± 0.18) cm (IVC-CI [(39 ± 8)%] in colorectal cancer group were significantly higher than those in IVC-CI group [(16 ± 13)%] Significance (P <0.01). HR decreased gradually to (82.4 ± 6.5) times / min, MAP increased to (74.5 ± 7.2) mm Hg, IVCe increased to (1.56 ± 0.21) cm, and IVCi increased significantly after treatment with 4ml / kg liquid of 4% succinyl gelatin injection (1.12 ± 0.34) cm, while the IVC-CI decreased to (29 ± 7)% and the CVP increased from (3.5 ± 1.1) mm Hg to (5.3 ± 2.1) mm Hg (P <0.05). HR decreased to (77.2 ± 5.8) times / min, MAP increased to (83.7 ± 8.6) mm Hg and IVCe increased after treatment with 4% succinyl gelatin injection 8 ml / kg liquid IVC-CI decreased to (21 ± 5)% and CVP increased to (7.4 ± 2.3) mm Hg, respectively, compared with that before treatment (1.88 ± 0.22) cm and IVCi increased to (1.52 ± 0.27) cm Statistical significance (P <0.01). At the same time, IVCe and IVCi were positively correlated with CVP before and after treatment with liquid (r = 0.782, r = 0.721, P = 0.000; r = 0.825, r = 0.796, P = CI was negatively correlated with CVP (r = -0.732 before treatment, r = -0.774 after treatment, P = 0.000). Conclusion IVC diameter and IVC-CI can guide the elderly patients with colorectal cancer before induction of anesthesia volume therapy.