张培才 陈勇 李斌飞

[摘要] 目的 探討上腔静脉形变指数在肝移植术中容量治疗中的应用及其对术后恢复情况的影响。 方法 选取2016年1月～2017年12月入住广东省中山市人民医院择期行肝移植手术的60例患者作为研究对象，按照随机、对照的设计原则将其分为研究组（n = 30）、常规组（n = 30）。研究组监测上腔静脉形变指数指导容量治疗，常规组监测中心静脉压（CVP）、动脉血压（ABP）和Swan-Ganz漂浮导管常规方法指导容量治疗，记录术中出入量和术后患者恢复情况。 结果 研究组术中输液总量、术中胶体液量、术中晶体液量均显著少于常规组，排便时间、排气时间、流质进食时间、住院时间均显著短于常规组，差异有高度统计学意义（P < 0.01）；术后两组腹内压均较术前明显升高，且研究组低于常规组，差异有统计学意义（P < 0.05或P < 0.01）；研究组术后并发症发生率为6.67%，低于常规组的16.67%，差异有统计学意义（P < 0.05）。 结论 临床中应用上腔静脉形变指数可以较好地指导肝移植术中容量治疗，减少术中输液量，促进术后排气、排便，快速恢复进食时间，减少术后并发症的发生。

[关键词] 肝移植术；容量治疗；上腔静脉形变指数；输液量

[中图分类号] R657.3 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0104-04

[Abstract] Objective To investigate the application of superior vena cava deformation index in volumetric therapy of liver transplantation and the effect on postoperative recovery. Methods A total of 60 liver transplantation patients from January 2016 to December 2017 in the Zhongshan People′s Hospital were collected as the study subjects， and they were divided into study group （n = 30） and routine group （n = 30） according to the principles of randomness and control. The volumetric treatment was monitored by the value of superior vena cava deformation index in the study group， while that was monitored by routine methods such as the CVP， ABP， and Swan-Ganz floating catheters in routine group. The volume of operation and postoperative recovery were recorded. Results The total amount of intraoperative fluid infusion， intraoperative colloid fluid volume， intraoperative lens fluid volume in the study group were less than those in the conventional group， the defecation time， degassing time， fluid intake time and length of stay shorter were than those in the conventional group， the differences were statistically significant （P < 0.01）. After surgery， the intra-abdominal pressures increased significantly compared with those before surgery in the two groups， and the study group was lower than that in the routine group， the differences were statistically significant （P < 0.05 or P < 0.01）. The incidence of postoperative complications in the study group was 6.67%， lower than that in routine group （16.67%）， the difference was statistically significant （P < 0.05）. Conclusion The application of superior vena cava deformation index can better guide the volumetric treatment of liver transplantation. The total amount of intraoperative fluid infusion and postoperative complications are reduced. Postoperative deflation and defecation， rapid recovery of eating are promoted.

[Key words] Liver transplantation； Volume therapy； Superior vena cava deformation index； Infusion volume

肝移植术是临床治疗肝癌的常见手术，且在临床中的应用比较广泛。肝移植手术过程中，适当补充液体对整个手术具有重要作用。其目的是维持手术患者的血流动力学稳定，并促进术后的恢复，减轻术后并发症，提高手术治疗效果[1]。临床研究显示，容量治疗的过程中常规的监测手段有中心静脉压（CVP）、动脉血压（ABP）和Swan-Ganz漂浮导管等。这些方法属于有创性监测手段，若操作不当，容易引起并发症[2-3]。随着临床医疗水平的不断提高，有学者提出监测上腔静脉形变指数进行指导容量治疗，其属于无创性检查手段，可重复性强[4]。本研究为了更好的了解上腔静脉形变指数在指导肝移植术容量治疗的效果，对其进行了深入探讨。……