Effect of passive leg lift test combined with non-invasive hemodynamic monitoring for postoperative fluid infusion management of patients
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摘要:目的 探讨被动抬腿试验联合无创血流动力学监测在术后患者补液管理中的效果。方法 选取80例行胸腹部手术术后患者为研究对象，随机分为观察组和对照组，每组40例。观察组给予被动抬腿试验联合无创血流动力学监测，对照组给予常规液体治疗。记录2组患者治疗前及治疗后6、24、48、72 h乳酸（Lac）水平；比较2组手术3 d后心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、血肌酐（Scr）水平，评价2种液体处理方案的优缺点。结果 观察组治疗后6、24 h Lac水平低于对照组，差异有统计学意义（P < 0.05）；2组治疗后48、72 h Lac水平与治疗前比较，差异无统计学意义（P>0.05）。治疗72 h后，观察组MAP水平高于对照组，HR、CVP、Scr低于对照组，差异有统计学意义（P < 0.05）。结论 被动抬腿试验联合无创血液动力学监测可降低急性肾损伤的发生率并缩短高乳酸血症的持续时间，治疗效果优于常规方法。Abstract:Objective To explore the effect of passive leg lifting combined with non-invasive hemodynamic monitoring in postoperative fluid management of patients.Methods A total of 80 postoperative patients with thoracic and abdominal surgeries were selected and were randomly divided into observation group(n=40) and control group(n=40). The observation group was given passive leg lifting combined with non-invasive hemodynamic monitoring, while the control group was given routine fluid treatment. The levels of lactic acid (Lac) were recorded before and 6, 24, 48 and 72 h after treatment in two groups. Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and serum creatinine (Scr) levels were compared between the two groups 3 days after surgery, and the advantages and disadvantages of the two fluid treatment schemes were evaluated.Results The lactic acid levels of 6 and 24 h after treatment in the observation group were significantly lower than those of the control group (P < 0.05). Lac levels in the two groups before treatment and at 48 and 72 h showed no significant differences (P>0.05). After 72 h of treatment, the MAP level of the observation group was significantly higher than that of the control group, and HR, CVP and Scr were significantly lower than those of the control group (P < 0.05).Conclusion Passive leg lifting combined with noninvasive hemodynamic monitoring can reduce the incidence of prerenal acute renal injury and shorten the duration of hyperlactic acidemia in postoperative fluid management, its advantage is better than conventional method.
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表 1 2组治疗前及治疗后6、24、48、72 h乳酸水平比较
mmol/L 时点 观察组(n=40) 对照组(n=40) 治疗前 2.85±0.60 2.91±0.60 6 h 1.86±0.50* 2.15±0.50 24 h 1.66±0.50* 1.96±0.50 48 h 1.44±0.50 1.45±0.50 72 h 1.34±0.50 1.35±0.50 与对照组比较, *P < 0.05。 
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表 2 2组治疗前、治疗72 h后HR、MAP、CVP、Scr水平比较
指标 时点 观察组(n=40) 对照组(n=40) HR/(次/min) 治疗前 120.30±16.50 129.90±16.50 治疗72 h后 85.50±12.60* 101.80±12.50* CVP/cmH2O 治疗前 9.20±3.80 9.90±3.50 治疗72 h后 7.80±2.30* 9.10±2.10* Scr/(μmol/L) 治疗前 176.61±18.22 176.15±18.37 治疗72 h后 136.12±16.10* 166.94±16.03* MAP/mmHg 治疗前 54.40±6.40 55.10±6.50 治疗72 h后 79.10±7.50* 72.90±7.70* HR: 心率; CVP: 中心静脉压; Scr: 血肌酐; MAP: 平均动脉压。与对照组比较, *P < 0.05。
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